Senile Dementia of Alzheimer Type

Clinical Presentation:

• Usually presents with memory deficit or personality changes
• Recent memory loss that affects job performance, difficulty performing familiar tasks, problems with language, disorientation of time and place, poor or decreased judgment, problems with abstract thinking, misplaced things, changes in mood or behavior, changes in personality, loss of initiative.
• May present as new-onset auditory hallucinations in elderly

Histology:

Prognosis:
Median survival is 4-6 years after initial diagnosis of Alzheimer disease

Carpal Tunnel Syndrome

Definition:
Carpal tunnel syndrome (CTS) is a compression neuropathy caused by constriction
of the median nerve where it passes beneath the flexor retinaculum of the wrist. It is
a common condition. The crude incidence rate in the UK of about one per thousand
person-years in hospital-diagnosed patients and twice that in primary care.

Clinical Features:

1. Tingling (paraesthesia), numbness, or discomfort in the thumb, index and
   middle fingers. Distressing tingling is often prominent by night, and the patient
   may need to exercise the fingers or shake the hand in attempt to gain relief.


2. Weakness and/or clumsiness of the hand, particularly in carrying out fine
   movements such as those concerned in writing, typing, sewing and other tasks
   necessitating pinch grip.


3. There is often forearm or elbow pain, aching in nature, poorly localised and
   exacerbated by activity. Some patients have shoulder pain. In advanced cases
   of median nerve entrapment, there is impaired sensation and thenar atrophy.

Aetiology:

Carpal tunnel syndrome usually presents as an isolated phenomenon but it is often
associated with other conditions especially where there is fluid retention or
inflammation. These include, diabetes mellitus (where it may be due to diabetic
mono-neuropathy rather than compression), the prolonged use of oral
contraceptives, pregnancy, Colles' or scaphoid fractures, other direct trauma, electric
shock, tenosynovitis, rheumatoid disease, osteoarthritis and gout. Obesity and short
stature are independent risk factors.

Colles' Fracture

Causes

The fracture is most commonly caused by people falling backward onto a hard surface and breaking their fall with extended outstretched hands.

Displacements

1. Proximal impaction
2. Dorsal displacement
3. Dorsal tilt
4. Ulnar tilt

Treatment

Treatment of depends on the severity of the fracture. An undisplaced fracture may be treated with a cast alone.The cast is applied with the distal fragment in palmar flexion and ulnar deviation. A fracture with mild angulation and displacement may require closed reduction. Significant angulation and deformity may require an open reduction and internal fixation or external fixation.

Radiograph showing a typical Colle's Fracture

Myositis Ossificans

Types:

• Nonhereditary Myositis Ossificans


• Myositis Ossificans Progressiva

Clinical Features:

Myositis ossificans usually presents with pain, tenderness, focal swelling, and joint muscle reduction, in the aftermath of a painful muscle contusion which resolved more slowly than expected, if at all.
The condition rarely is asymptomatic, and may sometimes be diagnosed from radiographs obtained for unrelated problems.
Most (i.e. 80%) ossifications arise in the thigh or arm, and are caused by a premature return to activity after an injury. Other sites include intercostal spaces, erector spinae, pectoralis muscles, glutei, and the chest. Hazy densities are sometimes noted ca. one month after injury, while the denser opacities eventually seen may not be apparent until two months have passed

Treatment:

Treatment is initially conservative, as some patients' calcifications will spontaneously be reabsorbed, and others will have minimal symptoms. In occasional cases, surgical debridement of the abnormal tissue is required, although success of such therapy is limited.

Radiograph of both feet

More Updates Soon

Dear readers,
I apologise for the absence updates on this blog.
I shall be contributing more frequently from now on.
Thanks.