Dr. Ebraheim’s educational animated video describing the anatomy and associated injuries of the knee joint.
Disrupted quadriceps
•Patient is unable to actively extend the knee.
The most common cause of ACL ruptures:
•Traumatic force being applied during twisting motion.
•Side stepping or landing from a jump.
Patient complains of:
•Immediate pain
•Knee giving way
•Swelling
Aspiration of the knee
•If aspiration of the knee joint shows evidence of blood within the joint there is 75-80% chance of ACL and meniscal injury.
Lachamn’s test- ACL knee exam
•Knee is flexed at 30 degrees.
•ACL tear of the knee is identified by pulling on the tibia and examining the frontward motion of the lower leg in comparison to the upper leg.
Radiological exam – ACL
•MRI of the knee joint shows bone lesions or bruising associated with tears of the ACL. Injury is found in the typical location; middle of the femoral condyle and posterior part of the tibia laterally.
Posterior cruciate ligament tear (PCL)
•Common cause of injury is a bent knee hitting a dashboard in a car accident.
Tibial Sag Test –PCL knee exam
Quadriceps active test-PCL knee exam
•The examiner stabilizes the leg of the patient and then the patient is asked to actively contract the quadriceps muscle.
•The tibia is seen actively reduced from the posterior subluxed position.
Lachman’s test-PCL knee exam
•Knee is bent 20-30 degrees.
•The posterior drawer test is carried out while the patient is in a supine position and the knee is flexed to 90 degrees.
•The amount of translation of the tibia relative to the femur is observed.
The dial test is performed while the patient is in the supine or prone position and both knees are in 90 and 30 degrees of flexion. More than 10 degrees of external rotation indicates significant injury.
Common meniscal tears
Symptoms include
•Knee pain
•Pain with straightening the knee
•Swelling
•Locking
•Weakness

The epididymis is a long coiled tube that lies above and behind each testicle. The epididymis collects and transports sperm from the testis to the vas deferens (tubes that transport sperm to the urethra). An epididymal cyst is a cyst-like mass in the epididymis that contains clear fluid. Typically, epididymal cysts and spermatoceles do not cause symptoms. When discovered, the epididymal cyst is usually about the size of a pea and feels separate from the top of the testis. Spermatoceles typically arise from the head of the epididymis, and are felt on the top portion of the testicle. Epididymal cysts and spermatoceles are often incidental findings on testicular self-examination or routine physical examination. It is important that any mass noted in the scrotum be examined by a urologist in order to obtain an accurate diagnosis, especially a mass on the testicle itself. Our team in the Division of Urology will typically be able to confirm the diagnosis on physical exam. However, a scrotal ultrasound may also be used in order to rule out other conditions.

Common causes of the knee pain
Knee pain is very common and in this video we will present the most common problems that can cause pain in the knee. (Patella) itself, which is in front of the knee, or from the tendons that are attached to the kneecap (patellar tendon and quadricep tendon). One of the most common problems is patellar chondromalacia which is chronic pain due to the softening of the cartilage beneath the kneecap. The cartilage of the kneecap will have some erosions, defects, or holes from mild to complete inside the joint (exactly in the back of the kneecap).
• Pain in the front of the knee
• Occurs more in young people
• Becomes worse from climbing up stairs and going downstairs
Treatment is usually nonsteroidal anti-inflammatory medication, physical therapy, and surgery is very rare. Also in front of the kneecap, the patient may get pain due to prepatellar bursitis.
When there is prepatellar bursitis, the patient will see that the swelling, the inflammation, and the pain is located over the front of the kneecap. The bursa becomes inflamed and fills with fluid at the top of the knee, causing pain, swelling, tenderness and a lump in that area on top of the kneecap. If the pain is in front of the knee but below or above the patella, this may indicate that the patient has tendonitis. Patellar tendonitis is an overuse condition that often occurs in athletes who perform repetitive jumping activities. Patellar tendonitis is a knee pain that is associated with focal patellar tendon tenderness and it is usually activity related. It is located below the kneecap and is called "jumper's knee". Patellar tendonitis affects approximately 20% of jumping athletes. There will be tenderness to palpation at the distal pole of the patella in extension and not in flexion. Quadriceps inflexibility, atrophy and hamstring tightness are predisposing factors for this condition. Treatment is rest, anti-inflammatory medication, stretching and strengthening of the hamstrings and quadriceps. Use an eccentric exercise program. The early stages of patellar tendonitis will respond well to nonoperative treatment. Another important cause of knee pain is a meniscal tear. The meniscus is the cushion that protects the cartilage in the knee. Injury will cause pain on the medial or the lateral side of the knee exactly at the level of the joint. The patient will complain of a history of locking, instability and swelling of the knee. McMurray test will be positive. A painful pop or click is obtained as the knee is brought from flexion to extension with either internal or external rotation of the knee. Arthritis of the knee Knee arthritis is very common. The cartilage cells die with age and its repair response decreases in the joint collapses with increased breakdown of the framework of the cartilage. The patient will have progressive blurring away of the cartilage of the joint with decreased joint space as seen on x-rays. Another source of pain is the Baker's cyst. The cyst is in the back of the knee between the semimembranosus yes and the medial gastrocnemius muscles. Another important source of knee pain is a ligament injury. Here is a normal knee without a ligament injury. Here you can see from the front, you can see the lateral and medial collateral ligament. You can see the ACL and PCL from the side view. These ligaments are usually injured as a result of a sports activity. Here is an example of a sports knee injury. Here is an example of the medial collateral ligament injury. This is the most commonly injury knee ligament injury to this ligament is on the inner part of the knee. Here is an example of an injury of the anterior cruciate ligament. It involves a valgus stress to the knee. Lachman test is usually positive, and MRI is diagnostic. Another important cause of knee pain is iliotibial band syndrome of the knee. Inflammation of the thickening of the iliotibial band results from excessive friction as the iliotibial band slides over the lateral femoral condyle. The iliotibial band is a thick band of fascia that extends along the lateral thigh from the iliac crest to the knee. And as the knee moves, the IT band was repeatedly shifted forwards and backwards across the lateral femoral condyle. The patient will complain of swelling, tenderness, and crepitus over the lateral femoral condyle. The condition occurs in the ITB S occurs in runners, cyclist and athletes that require repeated knee flexion and extension. The pain may be reproduced by doing a single-leg squat. The Ober's test is used to at assess tightness of the iliotibial band. MRI may show edema in the area of the ITB. Treatment is usually nonoperative with rest and ice, physical therapy, with stretching, proprioception, and improvement in neuromuscular coordination. Training modification and injections may be helpful. Surgery is a last resort. Surgical excision of the scarred inflamed part of the iliotibial band.

Friedreich's ataxia is an inherited disease that damages your nervous system. The damage affects your spinal cord and the nerves that control muscle movement in your arms and legs. Symptoms usually begin between the ages of 5 and 15. The main symptom is ataxia, which means trouble coordinating movements. Specific symptoms include Difficulty walking Muscle weakness Speech problems Involuntary eye movements Scoliosis (curving of the spine to one side) Heart palpitations, from the heart disease which can happen along with Friedreich's ataxia People with Friedreich's ataxia usually need a wheelchair 15 to 20 years after symptoms first appear. In severe cases, people become incapacitated. There is no cure. You can treat symptoms with medicines, braces, surgery, and physical therapy.

Conjoined Twins

This video shows how to perform the McMurray test, one of the most commonly used clinical assessment tools to assess for meniscal injuries in the knee.

This video clip is part of the FIFA Diploma in Football Medicine and the FIFA Medical Network. To enrol or to find our more click on the following link http://www.fifamedicalnetwork.com

The Diploma is a free online course designed to help clinicians learn how to diagnose and manage common football-related injuries and illnesses. There are a total of 42 modules created by football medicine experts. Visit a single page, complete individual modules or finish the entire course.

The network provides the opportunity for clinicians around the world to meet and share ideas relating to football medicine. Ask about an interesting case, debate current practice and discuss treatment strategies. Create a profile and log on to interact with other health professionals from around the globe.

This is not medical advice. The content is intended as educational content for health care professionals and students. If you are a patient, seek care of a health care professional.

Claudication, which is defined as reproducible ischemic muscle pain, is one of the most common manifestations of peripheral arterial occlusive disease (PAOD) caused by atherosclerosis. Claudication occurs during physical activity and is relieved after a short rest. Pain develops because of inadequate blood flow. Examination of a patient with claudication should include a complete lower-extremity evaluation and pulse examination, including measuring segmental pressures. Attempt to palpate pulses from the abdominal aorta to the foot, with auscultation for bruits in the abdominal and pelvic regions. When palpable pulses are not present, a handheld Doppler device may be used to assess circulation.

What is a brain aneurysm? A brain (cerebral) aneurysm is a bulging, weak area in the wall of an artery that supplies blood to the brain. In most cases, a brain aneurysm causes no symptoms and goes unnoticed. In rare cases, the brain aneurysm ruptures, releasing blood into the skull and causing a stroke. When a brain aneurysm ruptures, the result is called a subarachnoid hemorrhage. Depending on the severity of the hemorrhage, brain damage or death may result.

Pulmonary circulation is the portion of the cardiovascular system which carries deoxygenated blood away from the heart, to the lungs, and returns oxygenated (oxygen-rich) blood back to the heart. The function of pulmonary circulation is to exchange carbon dioxide for oxygen in the blood. It is the passage of blood from the heart to the capillaries of the lungs, where the gases are exchanged, and back to the heart to be pumped around the body.

The hepatic portal system is the system of veins comprising the hepatic portal vein and its tributaries. It is responsible for directing blood from the region of the gastrointestinal tract between the esophagus and rectum and also includes venous drainage from the supplementary organs such as the spleen and pancreas.

This particular video is intended as a demonstration of Neurologic Examination. This demonstration is intended as an example of a neurologic exam which may be used as part of the initial evaluation of patients with complaints that may have an underlying neurologic origin. This video is solely for educational purposes and intended for use to prepare for OSCEs incorporating standardized patient encounters. It is not intended as a demonstration of a comprehensive neurologic examination and is not intended as medical advice or medical guidelines.

It is not intended as a complete instructional video and should not be considered a source of complete physical examination instruction.

Instead, it should be treated as a supplement to independent learning using primary Osteopathic Clinical Skills instructional resources. Clinical skills are best learned and developed with support from faculty in the context of a complete Osteopathic Medical School Curriculum.

Osteopathic Clinical Skills is a channel dedicated to discussing and exploring Osteopathic Clinical Skills concepts for medical students, residents, and clinicians and presenting them in an easy to understand manner.

Attributions:
Many thanks to the University of North Texas Health Science Center Texas College of Osteopathic Medicine (UNTHSC - TCOM) for permitting use of the Simulation facilities and equipment during the production of this video.

Additional thanks to the UNTHSC-TCOM standardized patient and faculty volunteers who participated in this production and provided permission for the use of their image in this video.

The video will describe aerobic and anaerobic metabolim in mitochondria. Please visit my website for disclaimer.

She is a twenty years young female presented with large cystic swelling in anterior aspect of neck. The swelling was of size 6cmx 6cm x5 cm ,tense tender, cystic just above sternal nutch.This was diagnosed as large neck abscess ./nRepeated aspiration done but the swelling reappeared. So Incision & Drainage planned under local anaesthesia./nPatient in supine position. Surgery part painted and draped. Local anaesthesia 2% xylocaine with adrenaline used for field block.After giving local anaesthesia, I used a no 11 blade for stab incision at the most prominent part of the swelling, where skin was thin and fluctuation present./nPus drained form that opening. Little dilatation of opening to be done with artery forceps or sinus forceps. Complete pus drainage to be ensured.Little finger can be introduced inside the pus cavity to ensure proper drainage of pus. The cavity I use to clean with a gauge piece. If necessary curette biopsy can be taken from the wall of the cavity.These wounds usually need daily proper dressing for faster healing.

Leading cardiologists Valentin Fuster, MD, PhD, Director of Mount Sinai Heart and Herschel Sklaroff, MD, Clinical Professor of Medicine, Cardiology at Mount Sinai Heart were filmed for one-month for the “Making Rounds” documentary film as they cared for critically-ill heart patients in the Cardiac Care Unit at The Mount Sinai Hospital.

Watch Mount Sinai Heart doctors, fellows, residents, and nurses in action and saving lives demonstrating how simply listening to patients at the bedside remains medicine’s most indispensable tool over any technology.

In this film Mount Sinai Heart helps preserve the disappearing art and science of how to examine and diagnose patients at the bedside for future generations of physicians.

**This film was made possible by the generous support
of the McInerney Family.**

Copyright 2015 Middlemarch Films, Inc

Amenorrhea is the absence of menstrual bleeding.[1] Amenorrhea is a normal feature in prepubertal, pregnant, and postmenopausal females. In females of reproductive age, diagnosing amenorrhea is a matter of first determining whether pregnancy is the etiology. In the absence of pregnancy, the challenge is to determine the exact cause of absent menses.[2] Primary amenorrhea is the failure of menses to occur by age 16 years, in the presence of normal growth and secondary sexual characteristics. If by age 13 menses has not occurred and the onset of puberty, such as breast development, is absent, a workup for primary amenorrhea should start. Secondary amenorrhea is defined as the cessation of menses sometime after menarche has occurred. Oligomenorrhea is defined as menses occurring at intervals longer than 35 days apart. No consensus has been reached regarding the point at which oligomenorrhea becomes amenorrhea. Some authors suggest the absence of menses for 6 months constitutes amenorrhea, but the basis for this recommendation is unclear. For a post-menarchal girl or a reproductive-aged woman to experience a menstrual cycle interval of more than 90 days is statistically unusual. Practically speaking, this should be an indication for an evaluation to seek the cause.

Anterior vaginal wall relaxation (cystocele) is one of the most commonly diagnosed forms of pelvic organ prolapse in women. More than 200,000 cystocele repairs are completed yearly, however to date the procedures that are completed do not provide very high cure rates and/or poor anatomic outcomes. Successful treatment of anterior vaginal wall prolapse remains one of the most challenging aspects of pelvic reconstructive surgery we face. We have developed very good procedures that provide excellent support for the posterior wall (ie rectoceles) and the apex of the vagina (ie vaginal vault prolapse) and reproduce normal anatomy. We were one of the first centers in the country to utilize grafts in rectocele repairs and have seen improved cure rates to over 90% with minimal complications. It has been known for many years that abdominal sacralcolpopexy with placement of a mesh graft at the top of the vagina for vaginal vault prolapse is the most successful procedure in the literature. We have made advancements with this procedure as well in being able to offer our patients a laparoscopic minimally invasive approach for sacralcolpopexy, with the same excellent cure rates (>92%) and with hospital stays typically less than 24 hours and reduced complications. However the anterior wall has been one of the most difficult compartments in the vagina to get good anatomic results and high cure rates with traditional repairs and at the same time not cause sexual dysfunction, pain with intercourse, voiding dysfunction (ie incontinence or urgency/frequency syndrome), or a shortened or scarred down vagina. The transobturator approach was developed as a less invasive way to place an anterior wall graft (see below) however this still involved blind needle passes and the graft did not support the apex of the vagina, therefore the search for improvements in these procedures is ongoing.

When food is taken, it is broken down into smaller components. Sugars and carbohydrates are thus broken down into glucose for the body to utilize them as an energy source. The liver is also able to manufacture glucose. In normal persons the hormone insulin, which is made by the beta cells of the pancreas, regulates how much glucose is in the blood. When there is excess of glucose in blood, insulin stimulates cells to absorb enough glucose from the blood for the energy that they need. Insulin also stimulates the liver to absorb and store any excess glucose that is in the blood. Insulin release is triggered after a meal when there is a rise in blood glucose. When blood glucose levels fall, during exercise for example, insulin levels fall too. High insulin will promote glucose uptake, glycolysis (break down of glucose), and glycogenesis (formation of storage form of glucose called glycogen), as well as uptake and synthesis of amino acids, proteins, and fat. Low insulin will promote gluconeogenesis (breakdown of various substrates to release glucose), glycogenolysis (breakdown of glycogen to release gluose), lipolysis (breakdown of lipids to release glucose), and proteolysis (breakdown of proteins to release glucose). Insulin acts via insulin receptors.

Nystagmus is a condition of involuntary (or voluntary, in rare cases) eye movement, acquired in infancy or later in life, that may result in reduced or limited vision. Due to the involuntary movement of the eye, it has been called "dancing eyes"

Our results in this study of MIPO treated with conventional plates are comparable to the results of the femoral shaft fractures treated with intramedullary nailing. The technique can be used for all femoral shaft fractures. Although the biomechanics of the plate fixation are less stable compared to the intamedullary nail, the mechanical stability is stable enough for bone healing. Healing was rapid, and postoperative care was simplified. The two major complications were malalignment and screw breakage. We recommend using at least three separated screws in each fragment to prevent stress on the screw and screw breakage. Intraoperative limb length, axial alignment, and rotation must be carefully assessed to prevent malalignment. The limitations of our study include lack of a comparison group, retrospective data collection, and no randomisation in outcome evaluation

After miles and miles of use, a runner's legs take a beating. Running coach, John Henwood, explains the proper way to train so that runners can avoid painful knees.

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