By James R D Murray; Erskine J Holmes; Rakesh R Misra

Useful, easy-to-use reference for examining musculoskeletal issues, with fine quality photographs and multidisciplinary writer team.

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Sample text

Imperative to exclude septic arthritis on first presentation.  Symptomatic relief with NSAIDs is the mainstay of treatment. In recurrent attacks and particularly in the elderly consider intra-articular steroid injection.  Arthroscopic retrieval of loose bodies (if causing mechanical symptoms) and lavage of the joint have also been described with some success.  38 I Crystal deposition disorders Calcium pyrophosphate dihydrate deposition: advanced degenerative changes seen at the radiocarpal and distal radioulnar joints, with scapholunate separation and a large degenerative geode within the adjacent radial metaphysis.

Bilateral: 50% of idiopathic cases, or 80% in steroid-induced cases.  Commonly seen following intracapsular fractures of the femoral neck. Increased risk if displaced (up to 80%). g. g. deep sea divers – caisson disease), venous thromboembolism and bone-marrow transplant. I Clinical features Classically present with pain of insidious onset. Pain often worse at night. Pain is usually severe but may become more bearable after several weeks.    Radiological features The initial radiograph if taken early may be normal.

Mobilisation with either physiotherapy/chiropractor/self-physiotherapy.  ‘Graded lumbo-pelvic core stability programme’.  Act appropriately if ‘red flags’ present.   21 I A–Z of Musculoskeletal and Trauma Radiology Normal frontal and lateral views of the lumbar spine. A normal X-ray does not exclude a disc protrusion. Spondylolisthesis/spondylolysis 22 Characteristics  This is forward slip of one spinal vertebra on another.  Most commonly L4 on L5, or L5 on S1. e ‘spondylolysis’. The elements posterior to this defect (spinous process, laminae and inferior articular facets) remain as an isolated segment which becomes left behind as the anterior elements sublux forward.

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