2. Cause RSD/ CRPS

3. REFLEX SYMPATHETIC DYSTROPHY SYNDROME(RSD / CRPS)  a multi-symptom, multi-system, syndrome usually affecting one or more extremities, but may affect virtually any part of the body.  IT IS injury to a nerve or soft tissue (e.g. broken bone) not follow the normal healing path.

4. Clinical Features of RSD / CRPS  Pain  Skin changes  Swelling  Movement Disorder  Spreading Symptoms  Bone changes  Duration of RSD / CRPS

5. Stages of RSD / CRPS STAGE I  Onset of severe, pain limited to the site of injury  (hyperasthesia).  Localized swelling  Muscle cramps  Stiffness and limited mobility  STAGE II  Pain becomes even more severe and more diffuse.  Swelling tends to spread  STAGE III  Marked wasting of tissue (atrophic) irreversible.  paiN involve the entire limb.

6. Treatment Education  Educate About Therapeutic Goals  Encourage Normal Use of the Limb (Physical Therapy)  Minimize Pain  Determine the Contribution of the Sympathetic Nervous System to the Patient's Pain

7. Treatment

8. Q2 : neurse made elbow  Defination :  subluxation of the head of radius from its encirclement by annular ligament  most common age 6 yrs DUE TO the radial head is spherical and is mainly of cartilage;

9. Cause  - mechanism:  subluxation of the radial head generally results from a sudden pull on the upper limb  annular ligament either tears or slips over the radial head, allowing subluxation of radial head;

10. Clinical Presentation  injured elbow pronated, partially flexed and held by side; - forearm is pronated and the elbow is partially flexed; - there is anterolateral tenderness over the radial head; - usually occurs in children under age 4 and rare after age > 5; - the child presents with a flexed and pronated forearm supported closely to the trunk of the body; - the patient complains of pain around the radial head;

11. Treatment  These techniques are most effective if done within 12 hours of the injury  1-Supination maneuver  This consists of simultaneous supination of the forearm and extension of the elbow, followed by flexion of the elbow (with the palm supinated). The hand goes so far as to touch the shoulder. It is done swiftly and is usually effective. If this maneuver does not work, proceed to the pronation maneuver.  2-Pronation maneuver  With a handshake, the forearm is simultaneously pronated and the elbow is extended, followed by flexion of the forearm (with the palm pronated). It is done swiftly and it is usually effective.

13. Q3: Ulnar paradox  Def: it is reduces the claw-like appearance of the hand (Instead, the fourth and fifth fingers are simply paralyzed in their fully extended position)  The ulnar nerve also innervates the medial half of the flexor digitorum profundus muscle (FDP). If the ulnar nerve lesion:flexor digitorum profundus muscle  flexor digitorum profundus muscle may also be denervated. As a result, flexion of the IP joints is weakened  Treated by surgery.

14. Q4:Palmaris Brevis Origin: transverse carpal ligament and the superficial palmar fascia  Insertion: Hypothenar area skin (DERMIS)  Function: Tightens and corrugates the hypothenar skin, may deepen the concavity of the palm  Nerve: Motor Branch of Ulnar Nerve  Artery: Superficial Volar Branch of Ulnar artery

15. Q5: affecting of smoking on bone  Decreas Bone Mineral Density  Increase risk of Bone Fractures  Decrease Bone Healing Time and soft tissue, and surgical wounds  In older men and women who smoke, there is a significant bone loss  IN young age increases the risk of suffering from low bone mass  Malunion or non-union of bone may occur.  Risk of infection is increased.

16. Q6:transient synovitis  Def : is an inflammation and swelling of the tissues around the hip joint. one hip is affected. called "transient" because it lasts only a short time  It is the most common cause of sudden hip pain in children aged 3-10 years

17. CAUSE  Histories of trauma, which may be a cause or predisposing factor.  Increase in viral antibody  Postvaccine or drug-mediated reactions and an allergic disposition have been cited as possible causes.

18. Q7:femoral triangle  It appears as a depression  inferior to the inguinal  ligament when the thigh  is actively flexed at the  hip joint.

19. Boundaries  superiorly by the inguinal ligament.  medially by the medial border of the adductor longus muscle.  laterally by the medial border of the sartorius muscle.  The muscular floor of the femoral triangle is not flat but gutter-shaped.  It is formed from medial to lateral by the adductor longus, pectineus, and the iliopsoas  The roof of the femoral triangle is formed by the fascia lata, which includes the cribiform fascia. 

20. Contents  1- femoral artery and its branches, the  2- femoral vein and its tributaries  3- femoral nerve and its branches  4- the lateral cutaneous nerve  5- the femoral branch of the genitofemoral nerve  6- lymphatic vessels  7- Some inguinal lymph nodes.