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
Ganglions
Epidemiology
Most common tumour of hand
F > M
2nd - 4th decade
Aetiology
Unknown
Trauma
Mucoid degeneration of collagen tissue
Synovial herniation
Location
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