Cadmore media player playing video SLAC and SNAC Wrist for Orthopaedic Fellowship Examination
Video Player
Accessibility
Using forms mode, you can utilize keyboard shortcuts to make usability more efficient.
Space bar will play and pause the video. Pressing escape will close all displays and pressing it again will jump to the end of the player.
You can press A to open the Keyboard Shortcut Dialog which also provides an audio description of the player and all of its features.
Language
1x
Play Speed
Adjust Volume
Transcript
Search
Result Count
of
Click to jump to result
Search
Re-center
Segments
Result Count
of
Click to jump to result
Search
Name:
SLAC and SNAC Wrist for Orthopaedic Fellowship Examination
Description:
SLAC and SNAC Wrist for Orthopaedic Fellowship Examination
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/756cf737-4c90-4139-8a10-730b1d7172b1/videoscrubberimages/Scrubber_1.jpg
Duration:
T00H26M17S
Embed URL:
https://stream.cadmore.media/player/756cf737-4c90-4139-8a10-730b1d7172b1
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/756cf737-4c90-4139-8a10-730b1d7172b1/SLAC and SNAC wrist for Orthopaedic Fellowship Examination.mp4?sv=2019-02-02&sr=c&sig=ePB9S4L8978WViDhgLYCvg5G1Ao62ICt%2BnkKC0KZM1Y%3D&st=2024-11-21T17%3A50%3A45Z&se=2024-11-21T19%3A55%3A45Z&sp=r
Upload Date:
2024-05-31T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
Oh, so welcome everyone back, thank you for everyone who came back. I will hand you over to kashif to talk about SLAC and SNAC lesions in the wrist. So how I can share my screen just give you a slight overview of the slack and Slack crisp, and that is quite extensive topic. If you have any questions, then we can explain further.
OK, so SLAC, consider the two most common post-traumatic arthritis conditions, which we see in most of the head surgery units. And most of these, most of these cases, they are presented the radial sided wrist pain. And then if you take the history from those patients, they usually have a history of trauma in the past or any history of recent trauma.
And sometimes the patient can be presenting with the traumatic causes like a. Inflammatory, inflammatory arthritis or neuropathic conditions as well. But they are the enemy of the escape bit complex. So this is a ligament, which connects it with the skin for it, and it is divided into three components dorsal, volar and intermediate dorsal component is a breakup, which which it is strong and this movies of the physical fight with the rest of the wrist.
When you take when you. Take the detailed history and an examination you will most of the time, you will find that the patient is complaining of the a wristband and most of the time they have positive skin for shift or worse or test. And when you go for the radiographs of the patient, you will see there is a different pattern of the arthritis, which which can be divided on stages of stage one, which is a process between the radial steroid and escape wide.
And then it and then it will progress further to stage two, 3 and 4. Most of these radiographs do get off. You can see the widening of the carefully wooded area, which initially they call town was fine, but recently I come across with a surgeon who said, oh, it's a bit on the side. I'm not sure regarding that.
How come when it's called better to? Anyone come across through that? Now we hear it. Not sure if it has an official name, but but. Thomas St Thomas is most common here. Yeah, the comedian. Yeah, that's right. Yeah, I'm American comedian. Yeah OK.
So anyway, so coming to the staging of the process, so I said you wanted our process between radial and for wide. Stage two is our process between the whole of the radial fossa. Stage 3 is our process of the israeli-occupied and capital articulation, and stage 4 is pain escape for arthritis. So broadly, the treatment options are either do nothing or you can start with the conservative majority with a split edge and then a.
And you can give injections, you can go for dinner to start with. And then if for further options are either you can do that real estate like to me in stage one. And then you can progress either to limited Carpathian or for corner autopsies. So that depends on the stages of the disease itself. Egawa is a snake good for non-union Edwards collapse, so in snake people escape for fragment usually remains attached to the unit, which rotate together during extension, while distal escape for fragment rotates into flexion.
And this results in abnormal contact in a radioactive compartment, which is characterized by process of the red electrolyte. And then it will progress further to paint carpal arthritis. I think everyone knows the state is Beijing, which is a great one, is localized radial side of the square foot and radial Israelite two is a square foot capital along with stage one disease, and stage 3 is a very for process and radiographic findings.
There is a narrowing of the radius for it, and in this stage one, stage two, it will progress to capital unit. You might. You may find this and you may find carpal instability in terms of the busy deformity. I think. Regarding kinematics and carpal instability, I have made another talk which which is a little bit of detail.
I think we can do this next time. Again, on the angle, the skiffle unit angle is more than six. So the radiographer you will go for AP and lateral view. So there are two different angles, which you need to remember.
It's convoluted. Angles should be more than 60 and capitole unit angle should be less than 30. So these are the really graphs which show the state looks like. Stage two. Coming on the differential diagnosis.
I mentioned earlier, most of these patients they are presenting with radial sided wrist pain. So you can start from the soft tissue in terms of fear tendinitis. Then select snake and then that is divided into different stages. If you if a patient is presented with the metacarpal symptoms, then you can add abutment syndrome as well in the differential diagnosis.
And coming to the management of the snake wrist again, it started with do nothing immobilization with the splints and the inserts, you can give an injection of the steroids. And then the operative management will be again depending on the stage of the disease. So it will be the same either radial tenotomy arrest or dinner escape for excision.
The proximal rocker to me, and the final option will be either limited. That after these are for coroner. And the last option will be the are in severe disease. This is a type of the four kind of with one of the plates, which they affects all the four column, four columns of the rest along with it, it to me.
Any any question, guys? I think we just add a few questions. Yeah, it's a very difficult topic and I think just want to highlight that don't really need to know more than what cash has presented for the FARC. If you dig into it, you will find massive books written about these two topics.
And so you don't need you just need to stay safe and know the principles. Just just broad topics, the stages and basic treatment, I think. Yeah I think one other question is about in snark and Slack is that what is the last joint that could be affected? In the process of these two conditions, because the disease is so it's a start from the real astronaut, then whole of the whole of the radial fossa.
Then it will go to the capitellum unit and then it, then it will be very square for it. OK and there is one more question, which I think is important from damo is about. When it comes to patients in the clinic they present with the scaffold non-union. Do they all progress to snack or there? You know, so what's the disease? Progression is very variable.
Though, if a patient is coming to your clinic and if a patient is symptomatic, then it's likely to progress and you have to treat if a patient is asymptomatic because sometimes you find GP referral x ratios. Already, graphs show the non-union and patient is completely asymptomatic. Then you don't. You don't need to treat asymptomatic patient. Sure OK, so you can watch them?
Yeah, you don't have. You can. You can watch that because I've seen three patients in the last six months, which are referred by the GP and the radiographic findings. They have done the X-ray for some. Some other reason they found the patient has a scaffold non-union. And when we take a detailed history, so patients say, oh, I fell down a couple of years back, but I don't have any pain over there.
Yeah, Yeah. Now, David, I want to say something. Yes just to reiterate Kathy's point, it's symptoms rather than sort of radiological findings. So yes, if you X-ray one of the scaffold nonunion, they will have some form of arthritis, but not everyone will come up with pain. Now, I think there was a question from Muhammad to everyone who is asking about pros and cons of proximal car factory and four corner fusion proximal.
Now I think it's becoming more historical operation. The one big pro for it, though, is it is a quicker recovery. So with a four corner fusion, you have to wait for the bones to fuse before you can get the patients going. So people do to talk about a lot of stiffness, but it is a more robust sort of procedure with regards to another option. You don't really need to know much about it other than they might say is anything else in terms of options.
And that's wrist arthroplasty. You can say this is novel. It's only done by experienced surgeons have experience with it, but it is a limited use and it's still controversial. That's all you really need to say. If they push you for it, don't mention it unless they ask you about it. I think Siobhan also wants to comment. Yes, sorry.
Very, very nicely presented. But David is correct. You don't. You don't need to know too much about this, but there is a couple of points that you should always bring up when you're talking about management plans generally. Not just for this, you have non operative. Versus operative management, OK, you do not say something like do nothing.
Because do the thing is one of the options which which you come up according to this consent process. Yeah, no, I appreciate that. I do. But what I mean is if the patients presenting to your clinic don't say, I'm going to do nothing and say I'm going to exhaust non operative management plans such as pain relief analgesia in the spleen, teach physiotherapy, activity, modification and steroid injection as a last resort to treat once.
Presuming that has been exhausted, then I would offer this patient. So do you see the difference? And I you I'm not criticizing what you're saying. You're absolutely correct. This is an option in real life clinics, but that's doing nothing is not something you're going to say. You don't say it that way. You say I have no management time versus alternative.
And if the patient says, I don't want to do any of that and that's you, leave it alone or there's a third option. Thank you, Sean. A question to cash now is a capital unit. This is an option. Just an isolated. Capital it producers, is that. No, I never asked you this question. No, no, no.
Not just a capital unit. No, no. No question about it. Yeah, Yeah. Coming coming to your options of the rest of the city I went to. This is one of the courses in the UK. The guy from the I think he was from East Grinstead. It's good. Yeah, he loves it.
He loves the restorative policy option. OK, now, guys, be wary about suggesting normal operations, OK, these are I know you're working with risk surgeons and. I really appreciate your real life knowledge is far more than me and David as well. But we're talking about exam technique. Do not double operations or operations done by highly skilled surgeons. Oh, that's why I'm not mentioned even in my options, that I would go for it.
Now, I just wanted to make sure that you're aware that they might proffer that as another option. The only talk about it if the examiner mentions it and just say you understand it is done in highly specialist centers with experienced surgeons, but it is not part of your standard practice and the jury is still out on it in terms of research. So it's just I don't want people to be thrown by wrist replacements if the examiners may throw it at you.
As I say, it isn't something you should offer as an option. It's only if they question you about it. They may try to throw it at you on a younger patients to see. Yes Yes. Particularly as well. So that absolutely no fusion is the only option for younger patients only in the elderly or patients who we consider good. I think there are a few content regarding this proximal rocker to me.
So if a capitated by gritted proximally, then you can't go for proximal rocker, so you they need to keep in mind the proximal rocker connectome. The rehab is quicker and patient satisfaction rate 50-50 as compared to the rest of our services. But there is not risk for coronary field. If patient is young and they need stable wrist, then option will be for one or two reasons, although the chances of that nonunion and all other risk are still there.
Great I think that answers a mid question. He wanted to in a young patient what we do as opposed to older patients. Does it affect your management? So all options are the older patient is a proximal rocker factor because satisfaction rate in the older patients are high. But in the younger patient option option, a suitable option will be for counter-sued because they need stable wrist.
That's great. Thank you. Thank you. That's a great answer. Can I just switch question carpal fusion from distal radius across to the metacarpals used only for patients that have severe arthritis, but are in the manual labral phase of their life? That's another option.
Again, it's just need to think about the options cash. If that's correct, co-contribution is usually the one you go for. The thank you very much. I think we have Arthur with us, and he recently passed the exam and he's kindly joining us also to support the group, and he's been asked as question around this topic in his recent exam. Maybe he could, you know, enlighten us also with his experience.
So hello, everyone. Can you hear me? Yes, we can hear. Yes no. I only joined because me and kashif, our partner in crime, I just thought, you know? So yes, I've been asked this question in the exam. It comes up with all the.
So it comes up with a very odd looking x-rays rays victory, promising positive. And he says, what is it? So the first question was young laborer. 40-year-old had a wrist injury five years ago, has been struggling with the wrist and medial side pain, but can go to his activities of daily living, still work as a plumber and came to your clinic because he had enough.
What can you see on the x-ray? So what do you see on the X-ray say? You see an increased distance between a radial scaffold and unit. You see radial skylight are close to arthritis, you see schizoid involvement. And if decapitate is migrated approximately or not. So in my one, decapitate is migrated approximately. Then he asked me, what other?
What are the parameters? So as I mentioned, scaffold unit angle and capital scaffold angle, plus the disruptions of the glue lines and carpal index, you can bring it in for. So three radiographic parameters will do. Then, of course, the vibha goes on onto which joint involves first and why is the why is the radius of the radial arthritis a scaffold arthritis is?
Is the last why is the approximate pool of the escape for aid get involved last? So that is secondary to the kind of attacks as it becomes ball and socket joint. And it typically gets speared. And it only get involved once the capitals start migrating proximally. So these were the things to say and always in exam. Always patient was.
I had few other people as well who have been on this topic. The patient stays asymptomatic for treatment, stays on a non operative management only and very rarely progress to all these controversies of confusions and rest. If it goes there, then you know, before doing four corner fusion these days, they say, do a risk arthroscopy to see the state of unit forcer, to see if there is, you know, there is a process there or not, because the whole of the four corner will be resting on that.
I'm not a risk surgeon, so my knowledge finishes there. I'll probably stop. But in my case, I stopped at scaffold for removal and they lied to me. Plus a new risk to me about both Allen and pain it. That's highlights the importance of sticking to principles here and not talking about anything controversial. And as Sean said, it's could say, I am aware there is, you know, various procedures if you know of them, but stay safe and stick to principles.
Good any further comments from the mentors or anyone else has any questions. I think there's a question from Amit and Atif about motion preserving procedures in the young. Again, as atar was saying, you'll listen to the examiner, asymptomatic, asymptomatic, that's the key there. If they are symptomatic again and you correct me, is a good option if they want to preserve their preserve any motion.
However, function is the most important thing, and if they're doing a hard job like a plumber or a labral and they've got a lot of pain, then a fusion really is the only robust procedure at the moment currently of tested, tried and tested. That's my understanding. I don't know if kashif agrees with that one. So correct me. So if you're mentioning the option, so tell me is your option before proceeding or any body procedure?
Yes yeah, as I say, if they direct to me is a first port of call, if pain is their main problem. But as you said earlier, you want to maintain a stable wrist, particularly if they're a very active person. And unfortunately, the only way we have currently at the moment is a fusion. It's not a great option, but it's the only in terms of the BSA that is accepted as of thinking.
Just to summarize the how you manage a young person presenting to symptomatic, let's say, for the moment. First of all, activity notification, analgesia, spinach, physiotherapy and finally, steroid injections if the steroid injection gives symptomatic relief to the patient, even if it's temporary.
Consider doing an AM and pin reckoning with the radius and escape voyage if required. Skin removal or escape removal or total, then you're looking at your Fusion procedures and go step wise with effusion maintaining range of motion. But if it's a patient who is lot more to his risk for power, grip and strength, you may consider doing your carpal fusion across to the metacarpals.
These just keep it simple. Go stepwise through everything what you're saying. Don't get into the controversies and just say this is how I would manage this patient. Step by step. You don't start jumping straight into these a young guy. I'm going to give an infusion if you haven't talked about of options. First Now, if you answer the way Ashwin has done, they will just sit back and smile and be happy with you.
That's how, if they ask about management of it, that's how you should answer it. Good we just have one final question. Just we have a question about this. You mentioned the ball and socket joint. I think Arthur has mentioned this ball and socket joint, you know, when the proximal pole of the escape wire that is still attached with the loaded. So then that is separately from the.
So basically what happened is because skillful unit. Yes, it's a snack. So the nonunion happens at the distal pole and the proximal pole stays there and it stays with the unit. That becomes ball and socket it. It is explained in few lines in the new barnosky, which as well.
So how we I may forget something, so please forgive me for that. Thank you. That's that is what it is. Thank you both for explaining. I think we. Coming towards the end of this session, thank you, everyone who attended, and thank you for the mentors, particularly chickasha, for this nice presentation.
Next
Segment:0 .
Oh, so welcome everyone back, thank you for everyone who came back. I will hand you over to kashif to talk about SLAC and SNAC lesions in the wrist. So how I can share my screen just give you a slight overview of the slack and Slack crisp, and that is quite extensive topic. If you have any questions, then we can explain further.
OK, so SLAC, consider the two most common post-traumatic arthritis conditions, which we see in most of the head surgery units. And most of these, most of these cases, they are presented the radial sided wrist pain. And then if you take the history from those patients, they usually have a history of trauma in the past or any history of recent trauma.
And sometimes the patient can be presenting with the traumatic causes like a. Inflammatory, inflammatory arthritis or neuropathic conditions as well. But they are the enemy of the escape bit complex. So this is a ligament, which connects it with the skin for it, and it is divided into three components dorsal, volar and intermediate dorsal component is a breakup, which which it is strong and this movies of the physical fight with the rest of the wrist.
When you take when you. Take the detailed history and an examination you will most of the time, you will find that the patient is complaining of the a wristband and most of the time they have positive skin for shift or worse or test. And when you go for the radiographs of the patient, you will see there is a different pattern of the arthritis, which which can be divided on stages of stage one, which is a process between the radial steroid and escape wide.
And then it and then it will progress further to stage two, 3 and 4. Most of these radiographs do get off. You can see the widening of the carefully wooded area, which initially they call town was fine, but recently I come across with a surgeon who said, oh, it's a bit on the side. I'm not sure regarding that.
How come when it's called better to? Anyone come across through that? Now we hear it. Not sure if it has an official name, but but. Thomas St Thomas is most common here. Yeah, the comedian. Yeah, that's right. Yeah, I'm American comedian. Yeah OK.
So anyway, so coming to the staging of the process, so I said you wanted our process between radial and for wide. Stage two is our process between the whole of the radial fossa. Stage 3 is our process of the israeli-occupied and capital articulation, and stage 4 is pain escape for arthritis. So broadly, the treatment options are either do nothing or you can start with the conservative majority with a split edge and then a.
And you can give injections, you can go for dinner to start with. And then if for further options are either you can do that real estate like to me in stage one. And then you can progress either to limited Carpathian or for corner autopsies. So that depends on the stages of the disease itself. Egawa is a snake good for non-union Edwards collapse, so in snake people escape for fragment usually remains attached to the unit, which rotate together during extension, while distal escape for fragment rotates into flexion.
And this results in abnormal contact in a radioactive compartment, which is characterized by process of the red electrolyte. And then it will progress further to paint carpal arthritis. I think everyone knows the state is Beijing, which is a great one, is localized radial side of the square foot and radial Israelite two is a square foot capital along with stage one disease, and stage 3 is a very for process and radiographic findings.
There is a narrowing of the radius for it, and in this stage one, stage two, it will progress to capital unit. You might. You may find this and you may find carpal instability in terms of the busy deformity. I think. Regarding kinematics and carpal instability, I have made another talk which which is a little bit of detail.
I think we can do this next time. Again, on the angle, the skiffle unit angle is more than six. So the radiographer you will go for AP and lateral view. So there are two different angles, which you need to remember.
It's convoluted. Angles should be more than 60 and capitole unit angle should be less than 30. So these are the really graphs which show the state looks like. Stage two. Coming on the differential diagnosis.
I mentioned earlier, most of these patients they are presenting with radial sided wrist pain. So you can start from the soft tissue in terms of fear tendinitis. Then select snake and then that is divided into different stages. If you if a patient is presented with the metacarpal symptoms, then you can add abutment syndrome as well in the differential diagnosis.
And coming to the management of the snake wrist again, it started with do nothing immobilization with the splints and the inserts, you can give an injection of the steroids. And then the operative management will be again depending on the stage of the disease. So it will be the same either radial tenotomy arrest or dinner escape for excision.
The proximal rocker to me, and the final option will be either limited. That after these are for coroner. And the last option will be the are in severe disease. This is a type of the four kind of with one of the plates, which they affects all the four column, four columns of the rest along with it, it to me.
Any any question, guys? I think we just add a few questions. Yeah, it's a very difficult topic and I think just want to highlight that don't really need to know more than what cash has presented for the FARC. If you dig into it, you will find massive books written about these two topics.
And so you don't need you just need to stay safe and know the principles. Just just broad topics, the stages and basic treatment, I think. Yeah I think one other question is about in snark and Slack is that what is the last joint that could be affected? In the process of these two conditions, because the disease is so it's a start from the real astronaut, then whole of the whole of the radial fossa.
Then it will go to the capitellum unit and then it, then it will be very square for it. OK and there is one more question, which I think is important from damo is about. When it comes to patients in the clinic they present with the scaffold non-union. Do they all progress to snack or there? You know, so what's the disease? Progression is very variable.
Though, if a patient is coming to your clinic and if a patient is symptomatic, then it's likely to progress and you have to treat if a patient is asymptomatic because sometimes you find GP referral x ratios. Already, graphs show the non-union and patient is completely asymptomatic. Then you don't. You don't need to treat asymptomatic patient. Sure OK, so you can watch them?
Yeah, you don't have. You can. You can watch that because I've seen three patients in the last six months, which are referred by the GP and the radiographic findings. They have done the X-ray for some. Some other reason they found the patient has a scaffold non-union. And when we take a detailed history, so patients say, oh, I fell down a couple of years back, but I don't have any pain over there.
Yeah, Yeah. Now, David, I want to say something. Yes just to reiterate Kathy's point, it's symptoms rather than sort of radiological findings. So yes, if you X-ray one of the scaffold nonunion, they will have some form of arthritis, but not everyone will come up with pain. Now, I think there was a question from Muhammad to everyone who is asking about pros and cons of proximal car factory and four corner fusion proximal.
Now I think it's becoming more historical operation. The one big pro for it, though, is it is a quicker recovery. So with a four corner fusion, you have to wait for the bones to fuse before you can get the patients going. So people do to talk about a lot of stiffness, but it is a more robust sort of procedure with regards to another option. You don't really need to know much about it other than they might say is anything else in terms of options.
And that's wrist arthroplasty. You can say this is novel. It's only done by experienced surgeons have experience with it, but it is a limited use and it's still controversial. That's all you really need to say. If they push you for it, don't mention it unless they ask you about it. I think Siobhan also wants to comment. Yes, sorry.
Very, very nicely presented. But David is correct. You don't. You don't need to know too much about this, but there is a couple of points that you should always bring up when you're talking about management plans generally. Not just for this, you have non operative. Versus operative management, OK, you do not say something like do nothing.
Because do the thing is one of the options which which you come up according to this consent process. Yeah, no, I appreciate that. I do. But what I mean is if the patients presenting to your clinic don't say, I'm going to do nothing and say I'm going to exhaust non operative management plans such as pain relief analgesia in the spleen, teach physiotherapy, activity, modification and steroid injection as a last resort to treat once.
Presuming that has been exhausted, then I would offer this patient. So do you see the difference? And I you I'm not criticizing what you're saying. You're absolutely correct. This is an option in real life clinics, but that's doing nothing is not something you're going to say. You don't say it that way. You say I have no management time versus alternative.
And if the patient says, I don't want to do any of that and that's you, leave it alone or there's a third option. Thank you, Sean. A question to cash now is a capital unit. This is an option. Just an isolated. Capital it producers, is that. No, I never asked you this question. No, no, no.
Not just a capital unit. No, no. No question about it. Yeah, Yeah. Coming coming to your options of the rest of the city I went to. This is one of the courses in the UK. The guy from the I think he was from East Grinstead. It's good. Yeah, he loves it.
He loves the restorative policy option. OK, now, guys, be wary about suggesting normal operations, OK, these are I know you're working with risk surgeons and. I really appreciate your real life knowledge is far more than me and David as well. But we're talking about exam technique. Do not double operations or operations done by highly skilled surgeons. Oh, that's why I'm not mentioned even in my options, that I would go for it.
Now, I just wanted to make sure that you're aware that they might proffer that as another option. The only talk about it if the examiner mentions it and just say you understand it is done in highly specialist centers with experienced surgeons, but it is not part of your standard practice and the jury is still out on it in terms of research. So it's just I don't want people to be thrown by wrist replacements if the examiners may throw it at you.
As I say, it isn't something you should offer as an option. It's only if they question you about it. They may try to throw it at you on a younger patients to see. Yes Yes. Particularly as well. So that absolutely no fusion is the only option for younger patients only in the elderly or patients who we consider good. I think there are a few content regarding this proximal rocker to me.
So if a capitated by gritted proximally, then you can't go for proximal rocker, so you they need to keep in mind the proximal rocker connectome. The rehab is quicker and patient satisfaction rate 50-50 as compared to the rest of our services. But there is not risk for coronary field. If patient is young and they need stable wrist, then option will be for one or two reasons, although the chances of that nonunion and all other risk are still there.
Great I think that answers a mid question. He wanted to in a young patient what we do as opposed to older patients. Does it affect your management? So all options are the older patient is a proximal rocker factor because satisfaction rate in the older patients are high. But in the younger patient option option, a suitable option will be for counter-sued because they need stable wrist.
That's great. Thank you. Thank you. That's a great answer. Can I just switch question carpal fusion from distal radius across to the metacarpals used only for patients that have severe arthritis, but are in the manual labral phase of their life? That's another option.
Again, it's just need to think about the options cash. If that's correct, co-contribution is usually the one you go for. The thank you very much. I think we have Arthur with us, and he recently passed the exam and he's kindly joining us also to support the group, and he's been asked as question around this topic in his recent exam. Maybe he could, you know, enlighten us also with his experience.
So hello, everyone. Can you hear me? Yes, we can hear. Yes no. I only joined because me and kashif, our partner in crime, I just thought, you know? So yes, I've been asked this question in the exam. It comes up with all the.
So it comes up with a very odd looking x-rays rays victory, promising positive. And he says, what is it? So the first question was young laborer. 40-year-old had a wrist injury five years ago, has been struggling with the wrist and medial side pain, but can go to his activities of daily living, still work as a plumber and came to your clinic because he had enough.
What can you see on the x-ray? So what do you see on the X-ray say? You see an increased distance between a radial scaffold and unit. You see radial skylight are close to arthritis, you see schizoid involvement. And if decapitate is migrated approximately or not. So in my one, decapitate is migrated approximately. Then he asked me, what other?
What are the parameters? So as I mentioned, scaffold unit angle and capital scaffold angle, plus the disruptions of the glue lines and carpal index, you can bring it in for. So three radiographic parameters will do. Then, of course, the vibha goes on onto which joint involves first and why is the why is the radius of the radial arthritis a scaffold arthritis is?
Is the last why is the approximate pool of the escape for aid get involved last? So that is secondary to the kind of attacks as it becomes ball and socket joint. And it typically gets speared. And it only get involved once the capitals start migrating proximally. So these were the things to say and always in exam. Always patient was.
I had few other people as well who have been on this topic. The patient stays asymptomatic for treatment, stays on a non operative management only and very rarely progress to all these controversies of confusions and rest. If it goes there, then you know, before doing four corner fusion these days, they say, do a risk arthroscopy to see the state of unit forcer, to see if there is, you know, there is a process there or not, because the whole of the four corner will be resting on that.
I'm not a risk surgeon, so my knowledge finishes there. I'll probably stop. But in my case, I stopped at scaffold for removal and they lied to me. Plus a new risk to me about both Allen and pain it. That's highlights the importance of sticking to principles here and not talking about anything controversial. And as Sean said, it's could say, I am aware there is, you know, various procedures if you know of them, but stay safe and stick to principles.
Good any further comments from the mentors or anyone else has any questions. I think there's a question from Amit and Atif about motion preserving procedures in the young. Again, as atar was saying, you'll listen to the examiner, asymptomatic, asymptomatic, that's the key there. If they are symptomatic again and you correct me, is a good option if they want to preserve their preserve any motion.
However, function is the most important thing, and if they're doing a hard job like a plumber or a labral and they've got a lot of pain, then a fusion really is the only robust procedure at the moment currently of tested, tried and tested. That's my understanding. I don't know if kashif agrees with that one. So correct me. So if you're mentioning the option, so tell me is your option before proceeding or any body procedure?
Yes yeah, as I say, if they direct to me is a first port of call, if pain is their main problem. But as you said earlier, you want to maintain a stable wrist, particularly if they're a very active person. And unfortunately, the only way we have currently at the moment is a fusion. It's not a great option, but it's the only in terms of the BSA that is accepted as of thinking.
Just to summarize the how you manage a young person presenting to symptomatic, let's say, for the moment. First of all, activity notification, analgesia, spinach, physiotherapy and finally, steroid injections if the steroid injection gives symptomatic relief to the patient, even if it's temporary.
Consider doing an AM and pin reckoning with the radius and escape voyage if required. Skin removal or escape removal or total, then you're looking at your Fusion procedures and go step wise with effusion maintaining range of motion. But if it's a patient who is lot more to his risk for power, grip and strength, you may consider doing your carpal fusion across to the metacarpals.
These just keep it simple. Go stepwise through everything what you're saying. Don't get into the controversies and just say this is how I would manage this patient. Step by step. You don't start jumping straight into these a young guy. I'm going to give an infusion if you haven't talked about of options. First Now, if you answer the way Ashwin has done, they will just sit back and smile and be happy with you.
That's how, if they ask about management of it, that's how you should answer it. Good we just have one final question. Just we have a question about this. You mentioned the ball and socket joint. I think Arthur has mentioned this ball and socket joint, you know, when the proximal pole of the escape wire that is still attached with the loaded. So then that is separately from the.
So basically what happened is because skillful unit. Yes, it's a snack. So the nonunion happens at the distal pole and the proximal pole stays there and it stays with the unit. That becomes ball and socket it. It is explained in few lines in the new barnosky, which as well.
So how we I may forget something, so please forgive me for that. Thank you. That's that is what it is. Thank you both for explaining. I think we. Coming towards the end of this session, thank you, everyone who attended, and thank you for the mentors, particularly chickasha, for this nice presentation.
Next
Form Title Download
Transcript
Form Title Bookmark
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Share
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Form Title Accessibility and Keyboard Shortcuts
The cadmore media player is a professional video and audio player experience designed to deliver media as well as relevant transcript, segmentation, and metadata. On the screen is a traditional html video player with buttons such as play, pause, forward, captioning, language and play speed selection and more. Adjacent to the video player are generally tabs, one of which shows a scrolling transcript of the video and the other shows any segmentation of the media, sometimes referred to as chapters. At the top of the video is a menu bar containing an Explore button and Tools button. The Explore button allows you to dig deeper into the video by opening up an explore dialog which contains tabs for a visual navigation of the video using thumbnails, an about tab which contains rich metadata about the media, a segments tab which contains further information about the video, and a related tab which contains links to other media related to this media. The tools button opens a menu with options for sharing the media on social media, creating bookmarking links, creating embed codes for your website, generating citations, and more.
Keyboard Shortcuts
Keyboard shortcuts only work while you are in forms mode. By entering forms mode, you will be able to quickly access portions of the media player with single key commands.
Spacebar: Play/Pause Toggle
I: Info Menu,
O: Tools Menu
T: Transcript Tab,
S: Segments Tab
F: Forward 15,
R: Rewind 15
L: Languages,
P: Playspeed
M: Mute Toggle,
V: Volume Bar
N: Video Only Toggle,
B: Full Screen Toggle
C: Captions Toggle
Escape: Closes dialogs and menus / Exits Player
Z: Next Transcript Chapter
X: Previous Transcript Chapter
Q: Next Transcript Paragraph
W: Previous Transcript Paragraph
Entire Media
Segment(s)
Custom Clip
Start At:
End At:
Embed Size
-
You Size - Responsive
-
We Size - Responsive
-
Picture Overlay Popup
-
400 x 225
-
512 x 288
-
400 x 700
-
768 x 1024
-
1024 x 512
-
1280 x 608
Form Title Cite
No citation provided.
Info
Segments
Related
Thumbnails
Exit Clip Mode
You have requested to see a portion of the video outside of the clip.
Click OK to switch to the full video or click if you would like to stay inside the clip. You can always go back to the clip with Tools and Clip Mode