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A-1298 Practical anatomy and imaging
Jan-Ragnar Haugstvedt, Norway
Wednesday, June 13, 2018 · 4:03 p.m. · 14m 00s
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this the radial a joint we have four speakers so we also calls before speakers i am yawn
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along hoaxes from norway and we have the and that's flights are from switzerland easy here
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good is over there yeah him and then we have a great
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didn't uh from united kingdom and martin fun novel from belgium
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i am gonna starts and i was asked by bridget to talk about the
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practical and that to me an imaging and i asked her what
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is practical practical and that to me what is imaging she said the
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topic to be covered here is or or paxton approaches an instability
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it's that talk something about x. rated to scammer i net force
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copy but keep it simple because this is a course for
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the young surgeon should learn something but when i look at
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you it's not only the young searched which is great
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she said patients that's separate from almost every spain what are the causes and hold
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the diagonals so i will talk a little bit of service anatomy clinical examination
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imaging especially imaging including some special cases and summarise soul
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why do we now why do we need to know the topographic allow anatomy i'm sure
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that if i as all my residence even some of the my colleagues consultants
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if you show me the palm of the hand marked the m. c. p. joints some of them would miss
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and it's important for us to know where is that the topographic anatomy annette
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i'm sure most of you know it but for those who don't i young you should and we do it all the time
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you should go through the anatomy and examine the different structures that this
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the regular joint the little copper joint the l. t. interval
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the e. c. u. tandem processes style uh the allows dialogue with falwell region
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the f. c. u.
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propel paid their pizza form difficult to have met and when you've done that
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you could go on to the different tests the piano keys sign the
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radio compression test this stability test and it'll cop a stress test
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the piano keys sign sometimes the patient in the show
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you if there was an instability but basically
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you want to test for instability and you want to perform
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the block and test is is there an instability
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do you want to goal to see if there was an end point if there is no end point
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this is in any case in that there was a formal detachment but if there is an end point
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there is probably some fibres left don't to for region most of all you have to compare
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the injured to the non inter hand to this is to lose but dissolution both sides
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and if the patient doesn't have any complaints i would not operate on the patient
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they're different test this is a test that actually has been
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i investigated and show on that though it's a sensitivity
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and specificity of about ninety percent it's it for
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reassigned test where it with uh if
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you press your finger in between the e. c. u. f. c. you up towards
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please inform you get into the for the area and that is indicative of the
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t. s. a. t. and you re or that is it'll nor split here
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you also want to do that or you compression test to see if there was
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any pain between the raiders and the colour that you see stress test
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you want to do the wellness dialogue in punishment or the right but really test to
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see if there was any conflict between this dialogue and the track feet room
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you want to do the hours he knew she cried in test to see if there
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was any pain indicative up at five this uh so what about the imaging
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how do we engage the does the ready on the joint tortilla look into this
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well it definition is that a true eighty or actually we have a p. a. view
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is when the radials dialogue and well no style or are as
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far apart as possible and you still are able to
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have you in between the raiders and the cooler and this is important and i will show you cases why
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this is important so what is it true tied here that is
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when the palmer cortex all the piece of form is between the
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palm accord takes all the skate ford and the captive date
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and hide all climate here this is it true side view and as you can see
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the uh law and the raiders are on top of each other was well case is
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it true side here and you have to look for the piece of form
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if you don't you're gonna miss some dislocations these
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on the bottom they are not acceptable
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if you don't see the p. c. form between decapitated and
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escape would you do not have a exact side view
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you should also notice that if you point it was shipping it to hand
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that the light was shaped and as martin longer has shown us indisputable illustration there with
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links to the rate is relative but relies not cons and if you do
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rotate the arm into printed position there is some migration of the radius
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how do you take an x. ray of the waste this is what you usually see
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the patient this is sitting here just teasing dom down and pointed to perform
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is this correct well i just told it to point it on there will be proximate migration
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you ask for in ninety ninety beauty with
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ninety degrees abduction a shoulder ninety degrees
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objection the invasion in the l. one this is it true rates really front a. p. b.
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u. p. a. view of their waist and then the patient it also get to them
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on down here and ninety degrees and up in the you have nice site here
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she should also pay attention to if there was a great if there was a grip there
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was also approximate migration of the radius just look at the picture to the left here
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you see the flexed fingers and there was approximate variation of them all the raiders
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of course we should look at the different to worry isn't when you examine the patient
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but the question is is there any pain in well not deviation if we
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look to the almost harder the waste we know from this the paper
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it has been said that if you have an owner impacts and
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syndrome the patient with pain when you coloured deviate to hand
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i bolted lined the picture here and this is what it looks like it neutral but if
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i read ill deviate this you see that there was conflict between the overhead and illuminate
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but if you only deviated there's a conflict between the other had and the track feet from
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and you will see if you look at the m. arise uh some of the
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patients have changed just on the live in it somewhere on the truck
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feet room so i don't think it's true that's only in ola deviation patients
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with the lamp action has symptoms it could be integrated deviations as well
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coming to look for that the change it the you see in the alarm protection
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and the two class to in in in the palm of classification you
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should the changes here on the th says he that is him
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told him and there was a abnormality on the proximal the role now the question is can we use the m.
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arise or not sure you can but i usually set all
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depends how many tests let's the radiologist has available
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or what is it a slice of the cut of the images because sometimes we don't have
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as good a quick and as we should have to have a good amber ah
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this will be in rye showing some changes of the t. f. c. c.
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but are you sure say what ever you do an x.
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ray examination will always show an image of the reality
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while at false copy in my view would show the real
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picture so this is what you see when you perform
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and x. ray this is it's central t. f. c. t. or just looked down to the ruler had this is
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definitely we're not true correct and this is not good
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and this is approximate role use either change them
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to live in it and the trick fee to me this is definitely signs of an on ramp actions so
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this is one way to image the joint as well so i want to show you some images
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what you think oh this looks good it was bred that's normal if
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that is the doctors presenting are looking at this case that
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it was good but to the patient would suffering it would put in the cast for two weeks and then it came back
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so what you will say about this where is the piece of
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form well hybrid all apply the p. c. from here
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so it doesn't look good it in between the skateboard and the cap it that part
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there is this radius and all or a lot on top of each other
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so of course you can hold it the on to the p. c. from comes in the right
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position but then you also have to look for the relationship between the raiders and the owner
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the paging come back what what this you may say that this silence or for part
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but you don't have any view of the joint between the raiders and the girl
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also the patient in twenty august twenty seventeen this is what it looks like
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it doesn't look good in the distant grade on the joint but you know what's
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wrong it's not easy to say get it the information from this x. ray
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this is c. t. help this is c. t. taken indifferent to the
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positions and i used to do this but i don't think the
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again any uh get any information from this this is what we
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or the digits study at the mayo clinic when they had
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in a seat isn't different position with and without resistance so they
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tried to dislocated joint my experiences no it it's dislocated
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he stays the same whatever position you have so i don't take these yeah see
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this anymore in this case this is what you see this a young man
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so what is this this is definitely something wrong in the dis
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read it on a joint and if you look at this
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it's dislocated and there was a cinder still says it's table cannot rotate
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so if you had been there are careful from the very beginning he would've seen that this was
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something wrong and this is a young man what to do with the guy actually it's things
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this this stigma not looks pretty were good we can discuss this case later on is
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we can i ask what we should do with this case another thing
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is this isn't what you often see this is an old lady
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with the greater fracture over sideways pain what you do you perform a
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direct procedure it's based on five cases and twenty in nineteen twelve
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and it's why did done and it probably works well because it's done
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all or quite a few cases every year but i'm very
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hesitating to perform this procedure this was done in this lady
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but what happens when it comes and say it
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i'd almost sideways paying and look at the x. ray yeah and people say well there's nothing wrong
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loose checker total says if you do take its height beer and put
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some air forces on this uh wait this is what happens
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and the markets here show those there is you know the
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muscles upholding the ole not in their approximate direction
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so there will be an impeachment so if you take these pictures and allowed on this is what happens
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so you do have in a pinch men so you if you see a patient with the direct
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coming and complaining from all aside every spain load the forum and see what it looks like
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this is a clear sign that there indeed is an infringement so i just want him summary
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when you perform an extermination clinical x. men asian or radiological examination
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you just see if the patient has pain if the joint is stable
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if the imaging is normal and if it's unstable if it's abnormal provide a provocative
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testing or what kind of procedures you should do to treat the patients
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and this is becoming to a next we're gonna discuss different a
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treatment options for problems in the dissuaded on a joint
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and if you want to listen more to what we do that first coptic assisted
Conference Program
A-1298 Practical anatomy and imaging
Jan-Ragnar Haugstvedt, Norway
June 13, 2018 · 4:03 p.m.
132 views
A-1299 Reconstruction of TFCC
Andreas Schweizer, Switzerland
June 13, 2018 · 4:18 p.m.
292 views
