About Andy Neill

EM Reg/Resident based near Dublin. Former anatomy lecturer, theology student and occasional musician

018 Scapholunate injuries

More detail on the wrist and in particular the Terry Thomas sign and carpal instability. As always there’s much more going on in the x-ray than just the bones.

Please check out radiopaedia.org.

And some cases from the podcast.

http://radiopaedia.org/cases/scapholunate-dissociation

http://radiopaedia.org/cases/scapholunate-dissociation-1

http://radiopaedia.org/cases/lunate-dislocation

The big textbook I mentioned is Clinical Sports Medicine, available here. One of the lead authors, Karim Khan is even on Twitter and worth a follow.

015 – Superior Mesenteric Artery Syndrome

Hi guys. This is yet another Zebra diagnosis but it’s a great one for illustrating some of the relevant anatomy. Let me know what you think.

Here’s the link to the article mentioned

Rudinsky, Sherri L, and Michael J Matteucci. “Emergency Department Presentation of Superior Mesenteric Artery Syndrome: Two Cases in Marine Corps Recruits..” JEM 42, no. 2 (February 2012): 155–158. PMID 19111427

006.2 – Spinal Cord Injury

Here’s number 2. Let me know what you think

UPDATE:

The very smart and astute Chris Nickson points out that central cord syndrome normally presents with motor weakness in the distally (in the hands) rather than proximally in the case in the video.

My bad…

He is of course right and has a nice little mnemonic for remembering it MUD: Motor/Upper/Distal

And remember that the symptoms and signs are relative not absolute:

motor>sensory
upper>lower
distal> proximal

Based on the pure anatomy – with the corticospinal tracts arranged somatotopically with the highest spinal segments most medial – one would expect proximal weakness (C5,6 etc..) more than distal (C7-8, T1 etc…). But since when does the textbook play ball with reality! Maybe it’s just representative of the level of lesion in cervical cord (ie a lower lesion when the upper segments have already exited the cord) but it has me beat. Let me know if you have a better answer

Either way the more important thing is that central cord syndrome more usually presents with distal not proximal upper limb weakness.

Kudos to Chris for spotting it.

004 – Lisfranc injuries

Here’s the next (not so) exciting installment. Thanks for the emails and encouragement. Some neuro stuff is in progress!

And if you have a slightly more accurate account of where the LisFranc story is from then I’d love to know

As always this is free to re-use as you see fit, it’s also downloable for free too. If there’s technical things that are bugging let me know and I’ll see if I can fix them.

Andy