Join Our Mailing List

What We Do
Preventive Program
Adult Education and Literacy
Youth Program
Legal Services Program
Health Program
Anti-Violence Program
Khalil Gibran International Academy
I Need To Be Heard!

Program Contact Information

Danny Salim
Anti-Violence Program Manager
(718) 250 - 5122


By Q. Gancka. Sterling College, Vermont. 2018.

The needle is then The sciatic nerve divides into the common peroneal directed 10°–15° from the vertical plane with the leg externally rotated purchase 500 mg azithromycin visa. Once femur contact sensation to the lateral lower leg and dorsal aspect of is made the needle is grasped 2 cm above the skin purchase azithromycin 500 mg overnight delivery. The degree of approach is adjusted until decubitus with operative leg up and bent at the knee appropriate stimulation is achieved discount azithromycin 250 mg online. A line is drawn between the iliac crests with the patient in Sim’s position cheap azithromycin 100mg with visa. Along this line azithromycin 500mg otc, 5cm NERVE MOTOR SENSATION from midline, a needle is directed perpendicular to the Femoral Leg extension Anterior thigh and knee skin until quadriceps stimulation occurs, confirming Medial aspect of lower leg by saphenous correct placement. Lateral femoral None Lateral thigh The femoral nerve block is frequently performed and cutaneous well-tolerated for knee surgery. The nerve is located Obturator Adductors Medial thigh Tibial Plantar flexion and Heel and plantar aspect at the level of the inguinal crease lateral to the femoral inversion of foot of foot artery. By using increased volumes and distal pres- Common peroneal Dorsiflexion and Lateral lower leg and sure a “3–1” block may be achieved, but the obturator eversion of foot dorsal aspect of foot nerve is often not anesthetized. Central nervous system and cardiac effects from the insulated Tuohy needle introducer. There are also long-acting amide local anesthetic toxicity in the intact animal catheters with a metallic stylet that allow stimulation. New Drug delivery systems have been developed that are landmarks for the anterior approach to the sciatic nerve now allowing patients to go home with continuous block: Imaging and clinical study. Continuous plexus and peripheral nerve cantly affected if extended-duration long-acting local blocks for postoperative analgesia. Section VI REGIONAL PAIN Diffuse and poorly localized (with few “sensory” 22 ABDOMINAL PAIN visceral afferents and extensive divergence in the Alan Millman, MD central nervous system [CNS]) Referred to other locations (viscerosomatic conver- Elliot S. Krames, MD gence in the CNS) Accompanied by motor and autonomic reflexes (nausea, vomiting, diaphoresis, pallor, lower back INTRODUCTION muscle tension with renal colic, etc) Unreferred parietal pain is acute, intense, sharp, The abdomen is one of the most common sites of localized, and aggravated by movement, and may be regional pain. The physiologic mechanisms of visceral pain share similarities and differences with somatic MUSCULOSKELETAL PAIN pain mechanisms. Examples include, but are not limited to: rib fracture/disloca- CLASSIFICATION tion, intercostal cartilage fracture/subluxation, trauma with secondary abdominal wall hemorrhage, and Abdominal pain can be classified into pain caused by postoperative pain. Thoracic spine disorders can refer abdominal visceral disease, musculoskeletal pain, anteriorly. When stretched, the mesenteries provoke painful Vascular diseases, such as rupture of an abdominal stimuli. NERVES/PLEXUSES The parietal peritoneum derives its nerve supply from the spinal nerves, which also supply the correspon- ANATOMY OF THE ABDOMEN ding muscles and skin. Laterally by the external and internal oblique mus- cles, the rectus abdominis, the iliac muscles, and Vagus Nerves the bones. MUSCLES Anterolateral: flat muscular sheets (the external and Sympathetic Nerves internal obliques, the rectus abdominis). Here they synapse with Parietal: serous membrane lining the abdominal wall. OMENTA It is located inferior to the diaphragm, posterior to the Greater omentum: a two-layer peritoneal fold that stomach, just anterior to the aorta at the L1/L2 verte- descends downward from the stomach and duodenum bral body levels, and surrounding the celiac artery. S1 vertebral body, and the inferior hypogastric plexus Meissner’s plexus is in various muscle and submu- lies on either side of the rectum within the sacral pelvis. Splenic Tachycardia and hypotension or orthostatic hypoten- enlargement can cause percussion changes from reso- sion indicating hypovolemia/shock, bradycardia from nance to dullness on full inspiration. INSPECTION For light palpation, the flat of the hand, not the fin- General appearance: Patients with renal or biliary gertips, is used. Patients with peri- For deep palpation to ascertain organ size, the left tonitis lie still, avoid the slightest motion, and may hand is placed over the right and steady pressure is draw up their legs to reduce intraabdominal pressure. First, disease, lip/tongue telangiectasias from Osler– after the patient relaxes the abdominal muscles, the Weber–Rendu syndrome, or cushingoid facies. The physician then Abdomen: Increased intraabdominal pressure may asks the patient to contract the abdominal muscle by caused an everted umbilicus. Cachexia may be the placing his or her head to the chest; the physician pal- result of severe malnutrition or cancer. If tenderness is less during of the abdomen may result from obesity, gaseous abdominal contraction, then the process is intraab- distension, ascites, or organomegaly.

cheap 250 mg azithromycin visa

The brain is sometimes unable to distinguish whether axial low back pain is actually originating from the buttocks or low back (because both fibers use the L4–S1 nerve roots) generic azithromycin 500 mg on line. Low back pain is therefore sometimes perceived in a poorly defined distribution in both the low back and buttocks buy azithromycin 500 mg overnight delivery. Numerous potential causes of low back pain discount 100mg azithromycin amex, including more vague diagnoses buy 250 mg azithromycin fast delivery, such as “muscle strain discount azithromycin 250mg mastercard,” “muscle tightness,” and “myofascial pain,” have been reported. Conventional wisdom has been that 90% of cases of acute low back pain spontaneously resolve. In fact, systematic evaluation of the data has revealed that any- where from 40 to 90% of acute low back pain may initially resolve prior to 3 months. A more common picture of low back pain may be one of periodic remissions and relapses. However, when low back pain becomes chronic (lasting more than 3 months), the evidence regarding its etiology and pathophysiology is much more scientific and complete. In fact, research has shown that there are three common causes of chronic low back pain. Each of these causes has been scientifically validated and each is readily identified when the proper diagnostic investigations are rigorously pursued. Chronic low back pain has been shown to be caused by a painful intervertebral disc (discogenic low back pain) in approximately 39% of cases, a diseased Z-joint in up to 30% of cases, and sacroiliac joint dis- ease in approximately 15% of cases. This question will help you distinguish nociceptive pain from radic- ular pain (hip pain and axial low back pain are both nociceptive pain and must ultimately be distinguished during the physical examina- tion). Hip pain is often perceived in the hip and/or groin, although it may also be perceived in the knee. Common causes of hip pain include dislocation, fracture, and osteoarthritis. Axial low back pain with a referral pain pattern may also occur in the hip. It is more common, however, for axial low back pain with referral pain to occur in the buttocks and/or leg(s) in a pattern that is difficult to Low Back, Hip, and Shooting Leg Pain 67 Photo 1. Radicular pain, by contrast, is band-like and more easily localized as it radiates down the leg. Radicular symptoms over the anterior thigh that end at the knee are typically associated with the L3 nerve root. Radicular symptoms that extend over the medial knee, medial calf, and medial malleolus are typically associated with the L4 nerve root. Radicular symptoms that occur over the dorsum of the foot are typically associated with L5. Radicular symptoms that occur along the back of the thigh and the lateral heel are typically associated with S1. Photo 1 demonstrates the characteristic der- matomes of the lower extremity (Photo 1). Although knowing the location and distribution of pain is helpful, further questioning is necessary to determine if the pain is truly radicular, axial low back (with or without a referral pattern), or hip pain. This is the question that will definitively tell you if the patient has radicular pain or axial pain. Nociceptive pain (axial low back and hip pain) and referred pain are not sharp, shooting, or electric. Acute low back pain is defined as low back pain lasting less than 3 months and is much more likely to spontaneously resolve than chronic low back pain. Therefore, aggressive diagnosis and treatment of acute low back pain may not be necessary. Patients with radicular symptoms caused by spinal stenosis will clas- sically complain of pain aggravated by leaning backward. By contrast, patients with a disc herniation causing radicular symptoms will report increased symptoms with trunk flexion. This question is most useful for when you are deciding which diag- nostic studies to order, if any, and for selecting treatment options. Have you experienced any recent night sweats, weight loss, hema- turia, urinary retention, frequency, hesitancy, or cough?

best 500 mg azithromycin

The of the lateral edge of the foot will activate the peroneal opposite picture purchase azithromycin 100 mg with mastercard, i buy azithromycin 500mg without a prescription. The examination of the walking patient also includes observation of the knees cheap azithromycin 500 mg on line. During the stance phase Other investigations are the knees extended normally (i 250 mg azithromycin. Since hip dysplasia and clubfoot often occur togeth- hyperextension) or insufficiently extended (remain in er buy 250 mg azithromycin, an ultrasound scan of the hips is always indicated in flexion of more than 10°)? Clubfoot is also observed in connection with Examining the patient while walking on tiptoes and arthrogryposis and diastrophic dwarfism. Macrodactyly heels is also useful, as this is a quick and simple way of can be associated with the Klippel-Trenaunay and Proteus establishing whether coarse motor function is normal syndromes. Examination protocol for the upper ankle and foot Examination Question I. Medial longitudinal arch of the foot Normal, lowered, medial weight-bearing, elevated, footprint? Palpation Tenderness Calcaneus, malleoli, talus, navicular, forefoot Joint space in upper ankle Effusion, capsule swelling? Range of motion Ankle joint Dorsal extension/plantar flexion with extended (possibly also flexed) knee, active and passive Subtalar joint Valgus and varus movement Forefoot Pronation/supination Whole foot Inversion/eversion V. Stability Lateral stability of ankle and subtalar joint Forced inversion AP stability of upper ankle Anterior drawer test Examination of the standing patient Medial longitudinal arch of the foot: Observe whether ▬ Is there any swelling, redness or bulging? Evaluation of the footprint: The footprint under load ▬ Observation of the rearfoot axis: Is this in a physiological can be visualized either on the podoscope (a glass valgus position of approx. Variants of the forefoot are also observed the loaded zone can be inspected immediately after in respect of toe length (⊡ Fig. The callosity on the great toe must also be noted: neutral position, valgus foot provides information about functional weight- deviation (in the metatarsophalangeal or interphalan- bearing. Any superduction criterion for evaluating the formation of the longitu- or subduction of individual toes should also be noted. Forefoot variants: a intermediate foot (1st and 2nd toes roughly the same length), b Greek foot (2nd toe longer than the 1st), c Egyptian foot (1st toe longer than the 2nd) a b c ⊡ Fig. Medial arch of the foot from the medial side: a normal foot (or »flat valgus foot«), b flexible flatfoot, c pes cavus 370 3. Footprints: a normal foot with callusing under the 3rd metatarsal heads (rare in children and adolescents); d flexible flat- heel and the 1st and 5th metatarsal heads; b pes cavus with no foot with a missing medial arch, but otherwise normal weight-bearing weight-bearing in the metatarsal area; c splayfoot with widening of pattern; e heavy, rigid flatfoot with principal weight-bearing on the the forefoot and callus formation predominantly under the 2nd and medial side in the midfoot area (under the talus) Palpation functional respects, it is much more important to Examination of the supine patient perform this examination with the knee extended ▬ Tenderness: Typical painful sites in children and ado- rather than flexed, since the knee is extended during lescents are the heel (in calcaneal apophysitis), the walking. Dorsal extension is restricted in the extended lateral malleolus and the talar neck (in injuries or knee when the two-joint gastrocnemius is contracted. Grasping the lower leg with one hand, the ex- head (in juvenile hallux valgus) and the 2nd, 3rd or aminer grasps the calcaneus with the other and turns 4th metatarsal heads (in Freiberg’s disease or a stress it inwardly and outwardly (⊡ Fig. We describe simply whether the move- is readily observed and palpated in the ankle joint. Range of motion The combined rotational movement of the fore- and rearfoot is termed eversion and inversion, and is tested! Both sides should always be measured when by grasping the lower leg with one hand, the forefoot examining mobility in the upper and lower ankle. Since this test is likewise not very precise, we ▬ Ankle joint: dorsal extension/plantar flexion: The pa- restrict ourselves to descriptions such as »normal«, tient is examined in the supine position with the knee »increased« (in instability), »slight«, »greatly restrict- extended. Active: The patient tarsophalangeal joint, and possibly the interphalan- is asked to perform the same movement himself. In functional respects, however, the examina- extension and plantar flexion can be examined both with the knee tion with the knee extended is more important, since walking takes flexed and extended. The extent of dorsal extension is always slightly place in this position greater with the knee flexed than extended because of the relaxed a b c ⊡ Fig. Stating the a The heel is grasped with one hand and turned inwardly (b inver- result in degrees is not very useful. The examiner should simply state sion) and outwardly (b eversion) in relation to the lower leg. Normally, whether the movement is normal, restricted or completely absent. One hand stabilizes the heel (a), while the other rotates the forefoot inwardly (b prona- tion, 30–40°) and outwardly (c supination, 10–20°).

purchase azithromycin 250mg line

J Bone Joint Surg (Br) 75: 898–903 deficiency: Results of rotationplasty and Syme amputation cheap azithromycin 500 mg without a prescription. Luke DL purchase azithromycin 100mg, Schoenecker PL cheap 250 mg azithromycin amex, Blair VP order 100mg azithromycin with visa, Capelli AM (1992) Fractures Bone Joint Surg (Am) 77: 1876–82 after Wagner limb lengthening discount azithromycin 100 mg online. Maffulli N, Hughes T, Fixsen JA (1992) Ultrasonographic monitor- lengths of the normal femur and tibia in children from one to ing of limb lengthening. J Bone Joint Surg (Am) 59: 174–9 Der voll implantierbare Distraktionsmarknagel bei Verkürzun- 28. Nourbakhsh M, Arab A (2002) Relationship between mechanical gen, Deformitäten und Knochendefekten. Oesterman K, Merikanto J (1991) Diaphyseal bone lengthening thop 166: 199–203 in children using Wagner device: Long-term results. Bowen RJ, Levy EJ, Donohue M (1993) Comparison of knee mo- Orthop 11: 449–51 tion and callus formation in femoral lengthening with the Wag- 30. Ogilvie JW, King K (1990) Epiphysiodesis: Two-year clinical results ner or monolateral-ring device. Paley D, Fleming B, Catagni M, Kristiansen T, Pope M (1990) Me- throdesis in severe congenital femoral deficiency. A report of the chanical evaluation of external fixation used in limb lengthen- surgical technique and three cases. Brownlow H, Simpson A (2002) Complications of distraction os- lengthening by the Ilizarov technique. Cole J, Justin D, Kasparis T, De Vlught D, Knobloch C (2001) The in- method for predicting limb-length discrepancy. J Bone Joint tramedullary skeletal kinetic distractor (ISKD): first clinical results Surg Am 82:1432–46 of a new intramedullary nail for lengthening of the femur and 34. Polo A, Aldegheri R, Zambito A, Trivella G, Manganotti P, De Gran- tibia. Injury 32 Suppl 4:SD129–39 dis D, Rizzuto N (1997) Lower-limb lengthening in short stature. Correll J (1991) Surgical correction of short stature in skeletal An electrophysiological and clinical assessment of peripheral dysplasias. Ramaker R, Lagro S, van Roermund P, Sinnema G (2000) The (2003) Correction of tibia vara with six-axis deformity analysis and psychological and social functioning of 14 children and 12 ado- the Taylor Spatial Frame. Gabriel KR, Crawford AH, Roy DR, True MS, Sauntry S (1994) Percu- 55–9 taneous epiphysiodesis. Glorion C, Pouliquen JC, Langlais J, Ceolin JL, Kassis B (1996) Nordbo T (1991) Leg-length discrepancy measured by ultraso- Femoral lengthening using the callotasis method. Green W, Anderson M (1960) Skeletal age and the control of bone and after lengthening. Velazquez RJ, Bell DF, Armstrong PF, Babyn P, Tibshirani R (1993) längendifferenz. Orthopäde 19: 244–62 Complications of use of the Ilizarov technique in the correc- 15. Vitale M, Guha A, Skaggs D (2002) Orthopaedic manifestations limb-length discrepancy. Guichet J, Deromedis B, Donnan L, Peretti G, Lascombes P, Bado F (2003) Gradual femoral lengthening with the Albizzia intramedul- lary nail. Hefti F, Laer L von, Morscher E (1991) Prinzipien der Pathogenese The symmetrical gait is the most economical form of lo- posttraumatischer Achsenfehler im Wachstumsalter. Any asymmetry in the sequence of movements 20: 324–30 is indicative of a problem. Herzog R, Hefti F (1992) Problematik und Komplikationen der Be- complex process, there are numerous ways in which the inverlängerung mit dem Wagner-Apparat. Hope PG, Crawfurd EJ, Catterall A (1994) Bone growth following harmonious sequence of movements can be disrupted. Keijser L, Van Tienen T, Schreuder H, Lemmens J, Pruszczynski the various ways in which gait is impaired and summa- M, Veth R (2001) Fibrous dysplasia of bone: management and rizes the differential diagnosis of limping in tabular form outcome of 20 cases.

10 of 10 - Review by Q. Gancka
Votes: 197 votes
Total customer reviews: 197


The Arab-American Family Support Center is a 501(c)3 non-profit, non-sectarian organization that provides culturally and linguistically sensitive services to immigrant communities throughout New York City.  © 2017 All Rights Reserved.

AAFSC Brooklyn
150 Court Street, 3rd Flr
Brooklyn, NY 11201
T: 718 - 643 - 8000
F: 718 - 797 - 0410
E: info@aafscny.org
AAFSC Queens
37-10 30th Street, 2nd Fl.

Queens, NY 11101
T: 718 - 937 - 8000
F: 347 - 808 - 8778
AAFSC @ the Family Justice Centers
FJC Bronx (718) 508-1220
FJC Brooklyn (718) 250 - 5035
FJC Manhattan (212) 602-2800
FJC Queens (718) 575 - 4500
FJC Staten Island (718) 697 - 4300