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Ross Marquette : A 68-Year-Old Retired Executive With Severe Posterior Foot Pain

Learning Objectives Learn the common causes of foot pain. Learn the common causes of plantar fasciitis. Develop an understanding of the anatomy of the plantar fascia. Develop an understanding of the differential diagnosis of plantar fasciitis. Learn the clinical presentation of plantar fasciitis. Learn how to examine the foot. Learn how to examine the plantar fascia. Learn how to use physical examination to identify plantar fasciitis.…

Sarah Davidow: A 64-Year-Old Homemaker With Foot Pain

Learning Objectives Learn the common causes of foot pain. Develop an understanding of the unique anatomy of the digital nerves. Develop an understanding of the causes of Morton neuroma. Develop an understanding of the differential diagnosis of Morton neuroma. Learn the clinical presentation of Morton neuroma. Learn how to examine the foot. Learn how to use physical examination to identify Morton neuroma. Develop an understanding of…

Miranda Halliday: A 24-Year-Old Fashion Designer With Pain in Her Little Toe

Learning Objectives Learn the common causes of foot pain. Develop an understanding of the unique anatomy of the fifth metatarsophalangeal joint. Develop an understanding of the causes of bunionette. Develop an understanding of the differential diagnosis of bunionette. Learn the clinical presentation of bunionette. Learn how to examine the foot. Learn how to use physical examination to identify bunionette. Develop an understanding of the treatment options…

Bobby Moltisanti: A 48-Year-Old Meat Cutter With a Painful Bump on His Big Toe

Learning Objectives Learn the common causes of toe pain. Learn the common causes of toe deformity. Develop an understanding of the anatomy of the toe. Develop an understanding of the causes of hallux valgus. Develop an understanding of the differential diagnosis of toe pain. Learn the clinical presentation of hallux valgus. Learn how to use physical examination to identify hallux valgus. Develop an understanding of the…

Irina Antipova: A 72-Year-Old Violinist With Right Great Toe Pain

Learning Objectives Learn the common causes of toe pain. Develop an understanding of the unique anatomy of the interphalangeal joint of the toes. Develop an understanding of the causes of arthritis of the toe. Learn the clinical presentation of osteoarthritis of the toe. Learn how to use physical examination to identify pathology of the interphalangeal joint of the toes. Develop an understanding of the treatment options…

DeShawn Freely: A 29-Year-Old Basketball Player With the Feeling He Had Been Shot in the Ankle

Learning Objectives Learn the common causes of ankle pain. Develop an understanding of the unique anatomy of the ankle joint. Develop an understanding of the anatomy of the Achilles tendon and gastrocnemius muscle. Understand the function of the Achilles tendon. Develop an understanding of the causes of Achilles tendon rupture. Develop an understanding of the various types of Achilles tendon pathology. Learn the clinical presentation of…

Paul Reckinger: A 32-Year-Old Real Estate Agent With Severe Right Ankle Pain With an Associated Catching Sensation

Learning Objectives Learn the common causes of ankle pain. Develop an understanding of the unique anatomy of the ankle joint. Develop an understanding of the musculotendinous units that surround the ankle joint. Develop an understanding of the anatomy of the Achilles tendon. Develop an understanding of the causes of Achilles tendinitis. Develop an understanding of the differential diagnosis of Achilles tendinitis. Learn the clinical presentation of…

Chip Anderson : A 36-Year-Old Maintenance Man With Numbness and Paresthesias in the Sole of the Foot

Learning Objectives Learn the common causes of foot pain. Learn the common causes of foot numbness. Develop an understanding of the unique relationship of the posterior tibial nerve to the flexor retinaculum and bones of the foot. Develop an understanding of the anatomy of the posterior tibial nerve. Develop an understanding of the causes of posterior tarsal tunnel syndrome. Develop an understanding of the differential diagnosis…

Scott English: A 32-Year-Old Truck Mechanic With Pain and Electric Shocklike Sensation Radiating Into the Dorsum of the Foot

Learning Objectives Learn the common causes of ankle and foot pain. Learn the common causes of foot numbness. Develop an understanding of the unique relationship of the deep peroneal nerve to the dorsalis pedis artery and the ligaments and bones of the ankle and foot. Develop an understanding of the anatomy of the deep peroneal nerve. Develop an understanding of the causes of deep peroneal nerve…

Anna Coyle: A 24-Year-Old Dental Hygienist With Severe Medial Ankle Pain

Learning Objectives Learn the common causes of ankle pain. Develop an understanding of the unique anatomy of the ankle joint. Develop an understanding of the ligaments of the ankle. Develop an understanding of the causes of medial ankle pain. Develop an understanding of the differential diagnosis of deltoid ligament strain. Learn the clinical presentation of deltoid ligament strain. Learn how to examine the ankle and associated…

Shirley McCain: A 62-Year-Old Dance Instructor With Right Foot Pain

Learning Objectives Learn the common causes of foot pain. Develop an understanding of the unique anatomy of the midtarsal joint. Develop an understanding of the causes of midtarsal joint arthritis. Learn the clinical presentation of osteoarthritis of the midtarsal joint. Learn how to use physical examination to identify pathology of the midtarsal joint. Develop an understanding of the treatment options for osteoarthritis of the midtarsal joint.…

Ryan Rostov: A 52-Year-Old Male With Right Ankle Pain

Learning Objectives Learn the common causes of ankle pain. Develop an understanding of the unique anatomy of the ankle joint. Develop an understanding of the causes of ankle joint arthritis. Learn the clinical presentation of osteoarthritis of the ankle joint. Learn how to use physical examination to identify pathology of the ankle joint. Develop an understanding of the treatment options for osteoarthritis of the ankle joint.…

Chronic pain management

1 What is the definition of pain? The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Acute pain is associated with an identifiable cause (e.g., surgery, trauma, acute illness) and usually resolves with healing. Chronic pain is pain that occurs on at least half…

Acute pain management

1 Define acute pain Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Acute pain refers to pain of short duration (< 3 months), usually associated with a known cause, such as surgery, trauma, or an acute illness. Acute pain differs from chronic pain because its cause is usually known, it…

Neuraxial anesthesia and analgesia

1 What are the different kinds of neuraxial anesthesia? Epidural anesthesia refers to injection of anesthetics or analgesics into the epidural space at either the lumbar or thoracic level. Caudal anesthesia refers to injection into the sacral hiatus (see Question 11). Spinal anesthesia, spinal block, subarachnoid block, and intrathecal block are all terms used interchangeably to describe injection into the intrathecal space. 2 Differentiate neuraxial analgesia…

Nerve blocks for the head and neck

1 What are the indications for regional anesthesia in head and neck operations? The abundant nerve supply and reliably identifiable bony landmarks of the head and neck allow for the effective use of regional anesthesia techniques for head and neck operations. Depending on the patient and the type of surgery, regional anesthesia can be used as the primary anesthetic, or as part of a balanced anesthetic,…

Peripheral nerve and trunk blocks

1 Why would you perform a peripheral nerve block? Nerve blocks are generally performed for two major indications: anesthesia or analgesia. An anesthetic peripheral nerve block may allow a patient to avoid general anesthesia and periprocedural pain medication. This can be very helpful for patients with risk factors, such as a difficult airway or intolerance to general anesthesia. Analgesic blocks are similar but do not have…

Fundamentals of regional anesthesia

1 What are the indications and contraindications for regional anesthesia? Peripheral nerve blocks can provide surgical anesthesia and/or intra- and postoperative analgesia for upper and lower limb, thoracic, abdominal, breast, and head and neck surgeries. Common surgeries performed with nerve blocks include various orthopedic procedures, amputations, thoracotomies, laparotomies, arteriovenous fistula creations/revisions, and mastectomies. Contraindications for peripheral nerve block include patient refusal, sepsis/bacteremia, infection at injection site,…

Electroconvulsive therapy

1 What are the major indications for electroconvulsive therapy treatment? In the United States, electroconvulsive therapy (ECT) is used mainly to help treat patients with severe major depressive disorder, largely as a secondary treatment, after one or more trials of psychotropic medications have failed. ECT treatment can be the primary treatment when the clinical situation demands urgent symptomatic improvement. Some studies have shown ECT to be…

Shoulder operations

1 What types of orthopedic surgical operations are performed on the shoulder? The types of shoulder operations that are commonly performed include: arthroscopy for shoulder debridement, impingement syndrome, SLAP repair (superior labrum anterior and posterior), shoulder dislocation, and frozen shoulder, as well as rotator cuff repair, acromioclavicular joint repair, and shoulder replacement. 2 Describe the innervation of the shoulder joint. The shoulder joint, also known as…