Comparison of the Upper and Lower Limbs-A Phylogenetic Concept
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The Foot Angiosomes As Integrated Level of Lower Limb Arterial Perfusion
Research Article iMedPub Journals 2019 www.imedpub.com Journal of Vascular and Endovascular Therapy Vol. 4 No. 1: 7 The Foot Angiosomes as Integrated Level of Alexandrescu VA1* Pottier M1, Lower Limb Arterial Perfusion: Amendments Balthazar S2 and Azdad K3 for Chronic Limb Threatening Ischemia 1Department of Vascular and Thoracic Presentations Surgery, Princess Paola Hospital, Marche- en-Famenne, Belgium 2Department of Anesthesiology, Princess Paola Hospital, Marche-en-Famenne, Belgium Abstract 3Department of Radiology, Princess Paola Introduction: The angiosome concept was initially pioneered by Taylor and Palmer in the Hospital, Marche-en-Famenne, Belgium plastic reconstructive surgery field. The authors described a reproducible model of arterial and venous distribution in humans that follows specific three-dimensional (3D) networks *Corresponding author: Vlad Adrian of tissue. The angiosome model yet represents a specific level among other staged and Alexandrescu graduated levels of harmonious arterial irrigation in the lower extremity. Specific CLTI pathologies enhance characteristic arterial branches affectation, including the angiosomal source arteries. Evaluating main atherosclerotic lesions at peculiar Levels of arterial division [email protected] may afford useful clinical information. Department of Vascular and Thoracic Method: The present study proposes a description of six levels of degressive arterial division Surgery, Princess Paola Hospital, Marche- and collateral distribution in the inferior limb, including the angiosomal stage. Following en-Famenne, Belgium succeeding perioperative 2D angiographic observations over an eight-year period, these levels (I to VI) were analyzed (including the angiosomal Level III) and summarized in attached tables. The medical files of 323 limb-threatening ischemic foot wounds (Rutherford 4-6) in 295 patients (71% men) were retrospectively reviewed. -
Metatarsalgia
just the symptoms. What can I expect from treatment? With a proper diagnosis, and a well-rounded treatment plan including orthotics, the prog- nosis is excellent. With Sole Supports™ foot or- thotics you can expect either a dramatic loss The Truth About . of pain within the first weeks of use or a more gradual reduction of symptoms, depending Metatarsalgia on how long the problem has existed, normal body weight or how well you follow other ther- For more information and a apeutic regimens prescribed by your provider. professional consultation regarding Did you know that, with Sole whether Sole Supports may be Supports, metatarsal pads are rarely helpful for you, please contact the needed? following certified Sole Supports practitioner: What is it? Metatarsalgia is a term used to describe a pain- ful foot condition in the area just before the Arch Flattened small toes (more commonly referred to as the ball of the foot). The condition is characterized by pain and inflammation on the sole in the region of the metatarsal heads, which are the ends of the long bones in your foot. The joint This handout provides a general overview on this capsule or tendons may also be inflamed. topic and may not apply to everyone. To find out if this handout applies to you and to get more infor- mation on this subject, consult with your certified Sole Supports practitioner. Arch Restored The pain is generally aggravated by putting ments but your doctor is likely to recommend pressure off the metatarsals should also be pressure (as in walking) through the ball of a conservative approach first including: followed. -
Wound Classification
Wound Classification Presented by Dr. Karen Zulkowski, D.N.S., RN Montana State University Welcome! Thank you for joining this webinar about how to assess and measure a wound. 2 A Little About Myself… • Associate professor at Montana State University • Executive editor of the Journal of the World Council of Enterstomal Therapists (JWCET) and WCET International Ostomy Guidelines (2014) • Editorial board member of Ostomy Wound Management and Advances in Skin and Wound Care • Legal consultant • Former NPUAP board member 3 Today We Will Talk About • How to assess a wound • How to measure a wound Please make a note of your questions. Your Quality Improvement (QI) Specialists will follow up with you after this webinar to address them. 4 Assessing and Measuring Wounds • You completed a skin assessment and found a wound. • Now you need to determine what type of wound you found. • If it is a pressure ulcer, you need to determine the stage. 5 Assessing and Measuring Wounds This is important because— • Each type of wound has a different etiology. • Treatment may be very different. However— • Not all wounds are clear cut. • The cause may be multifactoral. 6 Types of Wounds • Vascular (arterial, venous, and mixed) • Neuropathic (diabetic) • Moisture-associated dermatitis • Skin tear • Pressure ulcer 7 Mixed Etiologies Many wounds have mixed etiologies. • There may be both venous and arterial insufficiency. • There may be diabetes and pressure characteristics. 8 Moisture-Associated Skin Damage • Also called perineal dermatitis, diaper rash, incontinence-associated dermatitis (often confused with pressure ulcers) • An inflammation of the skin in the perineal area, on and between the buttocks, into the skin folds, and down the inner thighs • Scaling of the skin with papule and vesicle formation: – These may open, with “weeping” of the skin, which exacerbates skin damage. -
Muscles Connecting the Upper Limb to the Vertebral Column
Muscles Connecting the Upper Limb to the Vertebral Column 1-Trapezius: O: external occiptal protuberance, superior nuchal line, ligamentum nuchae (along dorsal spine of cervical vertebra ), spines of all thoracic vertebrae and their supraspinous ligament " the extention of ligamentum nuchae ". Ins: (opposite to the Ori. Of Deltoid ) Upper fibers : Post. border lateral third of clavicle. Mid.(lateral fibers): inner surface of acromial process. Lower fibers: upper border of dorsal spine of scapula. N.S: Spinal accessory nerve (motor) and C3 and 4 (sensory) XI(11) cranial nerve (spinal part). *Note that accessory nerve = XI(11) cranial nerve which has 2 parts : cranial / spinal Action : Upper fibers :elevate the scapula. middle fibers: pull scapula medially toward the ribs (retracts). lower fibers: pull medial border of scapula downward . *anterior fibers rotates the scapula. Question 1 : to put your hand over your head what are the responsible muscles?? - Supraspinatus for initiation (0-15) or (0-18) - middle fibers of Deltoid (15 or 18 -90) - Trapezius & serratus anterior :after 90, rotation of scapula. Question 2 : to touch the acromial process of the other side which muscle is responsible , and which nerve will stop the movement of the muscle if we cut it?? -muscle: pectorals major , medial & lateral pectoral nerve. *always choose the easiest movement… 2-Latissimus dorsi : O: Iliac crest, lumbar fascia, spines of lower six thoracic vertebrae (T7-T12), lower three or four ribs, and inferior angle of scapula ,then all fibers make conversion to ins. Ins: Floor of bicipital groove of humerus. N.S: Thoracodorsal nerve (branch of post. Cord of post. -
Analyzing At-Home Prosthesis Use in Unilateral Upper-Limb Amputees To
2017 International Conference on Rehabilitation Robotics (ICORR) QEII Centre, London, UK, July 17-20, 2017. Analyzing At -Home Prosthesis Use in Unilateral Upper -Limb Amputees to Inform Treatment & Device Design Adam J. Spiers, Member, IEEE, Linda Resnik, and Aaron M. Dollar, Senior Member, IEEE Abstract — New upper limb prosthetic devices are continuously being developed by a variety of industrial, academic, and hobbyist groups. Yet, little research has evaluated the long term use of currently available prostheses in daily life activities, beyond laboratory or survey studies. We seek to objectively measure how experienced unilateral upper limb prosthesis-users employ their prosthetic devices and unaffected limb for manipulation during everyday activities. In particular, our goal is to create a method for evaluating all types of amputee manipulation, including non-prehensile actions beyond conventional grasp functions, as well as to examine the relative use of both limbs in unilateral and bilateral cases. This study employs a head-mounted video camera to record participant’s hands and arms as they Figure 1: A video screenshot from the head-mounted camera (for complete unstructured domestic tasks within their own homes. participant P2). A new ‘Unilateral Prosthesis-User Manipulation Taxonomy’ is presented based observations from 10 hours of recorded videos. has been a wide variety of prosthetic TDs (e.g. [4]–[6]). The taxonomy addresses manipulation actions of the intact However, follow-ups of how such devices’ are practically hand, prostheses, bilateral activities, and environmental and specifically used has been limited outside of the feature-use (affordances). Our preliminary results involved laboratory. Further motivation for the need of such tagging 23 minute segments of the full videos from 3 amputee understanding comes from well-known high prevalence rates participants using the taxonomy. -
Historical Aspects of Powered Limb Prostheses by Dudley S
Historical Aspects of Powered Limb Prostheses by Dudley S. Childress, Ph.D. INTRODUCTION People involved in work on powered limb from the viewpoint of important meetings and prostheses may wonder if the history of this events. Control approaches, another viewpoint, field is important. My answer is that one can are considered but not emphasized. Also, the learn a lot from history. Nevertheless, Hegel perspective is from America. has said, "What history teaches us is that men never learned anything from it." Unfortunately, PROLOGUE (1915-1945) it sometimes does seem true in prosthetics that we have not always profited from past experi The first powered prosthesis, of which I am ences. Too many aspects of the work are never aware, was a pneumatic hand patented in Ger published, and the multidisciplinary nature of many in 1915.13 A drawing of an early pneu the field produces papers in a broad spectrum of matic hand is shown in Figure 1. Figure 2 journals that are difficult to track. Books on the shows a drawing of what I believe to be the first field are, unfortunately, not numerous. electric powered hand. These drawings were The brief history that follows is by no means published in 1919 in Ersatzglieder und Arbeit complete, and since some of it involves years shilfen (Substitute Limbs and Work Aids).35 that are within readers' memories, I apologize This German publication illustrates the impor in advance for omissions that anyone may con tance of history in prosthetics, containing ideas sider significant. The history is intended to en that are still being discovered today. -
Human Glans and Preputial Development
Differentiation xxx (xxxx) xxx–xxx Contents lists available at ScienceDirect Differentiation journal homepage: www.elsevier.com/locate/diff ☆ Human glans and preputial development Xin Liu1, Ge Liu1, Joel Shen, Aaron Yue, Dylan Isaacson, Adriane Sinclair, Mei Cao, Aron Liaw, ⁎ Gerald R. Cunha, Laurence Baskin UCSF, USA ARTICLE INFO ABSTRACT Keywords: The urethra within the human penile shaft develops via (1) an “Opening Zipper” that facilitates distal canali- Development zation of the solid urethral plate to form a wide urethral groove and (2) a “Closing Zipper” that facilitates fusion Penis of the epithelial surfaces of the urethral folds. Herein, we extend our knowledge by describing formation of the Urethra human urethra within the glans penis as well as development of the prepuce. Forty-eight normal human fetal Human penile specimens were examined using scanning electron microscopy and optical projection tomography. Serial Glans histologic sections were evaluated for morphology and immunohistochemical localization for epithelial differ- Prepuce Canalization entiation markers: Cytokeratins 6, 7, 10, FoxA1, uroplakin and the androgen receptor. As the closing zipper completes fusion of the urethral folds within the penile shaft to form a tubular urethra (~ 13 weeks), canali- zation of the urethral plate continues in proximal to distal fashion into the glans penis to directly form the urethra within the glans without forming an open urethral groove. Initially, the urethral plate is attached ventrally to the epidermis via an epithelial seam, which is remodeled and eliminated, thus establishing me- senchymal confluence ventral to the glanular urethra. The morphogenetic remodeling involves the strategic expression of cytokeratin 7, FoxA1 and uroplakin in endodermal epithelial cells as the tubular glanular urethra forms. -
Metatarsalgia
Metatarsalgia Definition Metatarsalgia is a generic term for pain or discomfort in the sole of the forefoot (the ball of the foot). It is an inflammatory condition of the metatarsal heads due to a drop or collapse of the metatarsal arch. The arch flattens and the bone ends (metatarsal heads) move closer together causing the soft tissue to be pinched or trapped between the bones. With every step, the arch rises and falls causing repeated stress to the area. More specific type of Metatarsalgia can be: • Morton’s Neuroma ( nerve issue) • Bursitis • Arthritic joint change • Stress Fractures Symptoms • Vague pain, ache or burning in the sole of the forefoot, during weight-bearing activities • Tingling / numbness in toes • Sharp or shooting pain in toes • Aggravated when dorsi-flexing (lifting) toes • Callousing under 2nd, 3rd and 4th toes • Feeling of “walking on pebbles” Causes Anything that puts extra stress on the forefoot can cause Metatarsalgia. Common examples are: • Use of improper footwear (i.e. high-heeled shoes and boots) • High-arched or “cavus” foot or flat arch feet “pes planus” which causes the bones in the front of the foot (metatarsals) to point down into the sole to an excessive extent, or a long metatarsal bone which takes extra pressure • Claw or hammer toes which press the metatarsals down towards the ground • A nerve problem near the 3rd and 4th toes • A stretched or irritated nerve in the ball of the foot (inter-digital neuroma) or behind the ankle (tarsal tunnel syndrome) can produce pain in the ball of the foot • A bunion or arthritis in the big toe can weaken the big toe and throw extra stress onto the ball of the foot. -
Treatment of Spastic Foot Deformities
TREATMENT OF SPASTIC FOOT DEFORMITIES penn neuro-orthopaedics service Table of Contents OVERVIEW Severe loss of movement is often the result of neurological disorders, Overview .............................................................. 1 such as stroke or brain injury. As a result, ordinary daily activities Treatment ............................................................. 2 such as walking, eating and dressing can be difficult and sometimes impossible to accomplish. Procedures ........................................................... 4 The Penn Neuro-Orthopaedics Service assists patients with Achilles Tendon Lengthening .........................................4 orthopaedic problems caused by certain neurologic disorders. Our Toe Flexor Releases .....................................................5 team successfully treats a wide range of problems affecting the limbs including foot deformities and walking problems due to abnormal Toe Flexor Transfer .......................................................6 postures of the foot. Split Anterior Tibialis Tendon Transfer (SPLATT) ...............7 This booklet focuses on the treatment of spastic foot deformities The Extensor Tendon of the Big Toe (EHL) .......................8 under the supervision of Keith Baldwin, MD, MSPT, MPH. Lengthening the Tibialis Posterior Tendon .......................9 Care After Surgery .................................................10 Notes ..................................................................12 Pre-operative right foot. Post-operative -
Stretching and Positioning Regime for Upper Limb
Information for patients and visitors Stretching and Positioning Regime for Upper Limb Physiotherapy Department This leaflet has been designed to remind you of the exercises you Community & Therapy Services have been taught, the correct techniques and who to contact with any queries. For more information about our Trust and the services we provide please visit our website: www.nlg.nhs.uk Information for patients and visitors Muscle Tone Muscle tone is an unconscious low level contraction of your muscles while they are at rest. The purpose of this is to keep your muscles primed and ready to generate movement. Several neurological causes may change a person’s muscle tone to increase or decrease resulting in a lack of movement. Over time, a lack of movement can cause stiffness, pain, and spasticity. In severe cases this may also lead to contractures. Spasticity Spasticity can be defined as a tightening or stiffness of the muscle due to increased muscle tone. It can interfere with normal functioning. It can also greatly increase fatigue. However, exercise, properly done, is vital in managing spasticity. The following tips may prove helpful: • Avoid positions that make the spasticity worse • Daily stretching of muscles to their full length will help to manage the tightness of spasticity, and allow for optimal movement • Moving a tight muscle to a new position may result in an increase in spasticity. If this happens, allow a few minutes for the muscles to relax • When exercising, try to keep head straight • Sudden changes in spasticity may -
Bone Limb Upper
Shoulder Pectoral girdle (shoulder girdle) Scapula Acromioclavicular joint proximal end of Humerus Clavicle Sternoclavicular joint Bone: Upper limb - 1 Scapula Coracoid proc. 3 angles Superior Inferior Lateral 3 borders Lateral angle Medial Lateral Superior 2 surfaces 3 processes Posterior view: Acromion Right Scapula Spine Coracoid Bone: Upper limb - 2 Scapula 2 surfaces: Costal (Anterior), Posterior Posterior view: Costal (Anterior) view: Right Scapula Right Scapula Bone: Upper limb - 3 Scapula Glenoid cavity: Glenohumeral joint Lateral view: Infraglenoid tubercle Right Scapula Supraglenoid tubercle posterior anterior Bone: Upper limb - 4 Scapula Supraglenoid tubercle: long head of biceps Anterior view: brachii Right Scapula Bone: Upper limb - 5 Scapula Infraglenoid tubercle: long head of triceps brachii Anterior view: Right Scapula (with biceps brachii removed) Bone: Upper limb - 6 Posterior surface of Scapula, Right Acromion; Spine; Spinoglenoid notch Suprspinatous fossa, Infraspinatous fossa Bone: Upper limb - 7 Costal (Anterior) surface of Scapula, Right Subscapular fossa: Shallow concave surface for subscapularis Bone: Upper limb - 8 Superior border Coracoid process Suprascapular notch Suprascapular nerve Posterior view: Right Scapula Bone: Upper limb - 9 Acromial Clavicle end Sternal end S-shaped Acromial end: smaller, oval facet Sternal end: larger,quadrangular facet, with manubrium, 1st rib Conoid tubercle Trapezoid line Right Clavicle Bone: Upper limb - 10 Clavicle Conoid tubercle: inferior -
The Indications for Toe Transfer After ''Minor
ARTICLE IN PRESS Invited personal view article THE INDICATIONS FOR TOE TRANSFER AFTER ‘‘MINOR’’ FINGER INJURIES F DEL PINAL* From the Institute for Hand and Plastic Surgery, Private Practice, and Mutua Montan*esa, Santander, Spain Toe-to-hand transfer is widely considered to be unjustified for ‘‘minor’’ finger injuries. In this invited personal view article the indications for toe-to-hand transfer for finger amputation and neurocutaneous and major pulp defects are discussed, and a classification of multidigital injury that has both prognostic and decision-making value is presented. In the author’s opinion a toe transfer should always be considered as an option when reconstructing ‘‘minor’’ finger injuries, as it can reproduce significant long-term benefit to the hand and the patient’s sense of well being. The procedure should be carried out in the acute period, not only because it is technically easier and better for hand function, but above all because the surgeon can save structures that will be lost if the transfer is delayed. Journal of Hand Surgery (British and European Volume, 2004) 29B: 2: 120–129 Keywords: microsurgery, toe-to-hand, finger amputation Since the hand is always naked and exposed, even if reconstruction. In this personal view article only the only the fingertip is lost, it presents a very large most ‘‘typical’’ indications will be discussed. The handicap for the patient. (Hirase! et al., 1997) metacarpal hand (Tan et al., 1999; Wei et al., 1997, 1999; Yu and Huang, 2000), congenital reconstruction There was a time when only loss of the thumb was (Kay and Wiberg, 1996; Shibata et al., 1998; Van Holder considered an acceptable indication for toe-to-hand et al., 1999), joint transfer (Dautel and Merle 1997; transfer (Buncke et al., 1973; Cobbett, 1969).