10% of elbow tendonitis
Overuse injury
- poor swing in golf
- poor throwing technique
- overuse of topspin in tennis
- occupational (repetitive hammering / screwing)
Some patients also have lateral epicondylitis
Tenderness CFO
Stimulate pain
- flexion of WJ with fingers resisting
Lateral : Medial 9:1
4th & 5th decades
- M = F
- 75% dominant arm
50% of regular tennis players
- especially > 2 hrs / week
Insertion pathology / Enthesopathy
Over-extension of the elbow with supination / pronation
Lateral epicondyle
- anconeus from posterior face
- ECRB and EDC from anterior face (CEO)
Occurs 10% of supracondylar humeral fractures
- varus malunion
Lateral condyle fracture
- AVN trochlea
Growth arrest of medial aspect physis
- rare
- post traumatic
Most common lower limb neuropathy
Valgus TKR - 3%
HTO - 10%
Direct Trauma / Compression
Knee Dislocation
Tibial fracture
Cast / Dressing
Lateral Meniscus Repair
Inflammation of achilles tendon; insertional or noninsertional
Tendonitis / Tendonosis / Rupture
Triceps surae
- medial and lateral gastrocnemius
- soleus
- surrounded by paratenon which allows gliding and supplies nutrition
Inserts middle 1/3 calcaneal tuberosity
- 2 x 2 cm area
- 90o rotation distally
Retrocalcaneal bursa (x2)
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
Lateral compartment of leg
- run through retromalleolar groove
- pass superior and inferior to peroneal tubercle
- covered by inferior peroneal retinaculum
Peroneus longus
- origin lateral condyle of tibia and head fibula
- tendon PL superficial and inferior to brevis in retromalleolar groove
- runs in cuboid groove
- insert plantar surface base of 1st MT and lateral aspect medial cuneiform
80% cancer patients have spinal metastasis at autopsy
Spine is number one site for bony metastasis (50%)
Hexagon: PBBLTK
Prostate Breast
Structural kyphosis of thoracic or thoracolumbar spine
- characterised by vertebral wedging & subsequent growth disturbance of vertebral end plate
1. Kyphosis > 45°
2. > 5° wedging 3 or more adjacent apical vertebrae
Other features
- Schmorl nodes
M:F =2:1
30-40 years
20% diabetic
50-80% identifiable source
Lumbar (50%) > Thoracic > Cervical (<10%)
1. Haematogenous
- arterial rather than venous
Risk factors
- UTI (40% of all cases)
- IVDU
- elderly