Ulnar drift or deviation of fingers Normal anatomical factors contributing to ulnar drift of fingers at MCP joint: Normal mechanical advantage of ulnar intrinsic muscles Asymmetry and ulnar slope of metacarpal heads of index and middle fingers Greater ulnar deviation permitted by radial collateral ligament when MCP joint is flexed…
Tag: Orthopedics
Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Gout : Mnemonics
Urate Lowering Therapy (ULT) Mnemonic: 1, 2, 3, 4, 5, 6 Start Urate Lowering Therapy if: ≥1 subcutaneous tophi ≥2 flares per year ≥3 stage CKD with Serum uric acid (SUA) ≥ 9 mg/dl Other indications: Urate renal stone, Evidence of joint destruction in X-ray 4. ≥4 weeks to be…
Surgical Skills 
Percutaneous Achilles Tenotomy for CTEV
Indications Cavus, Adductus and Varus are fully corrected but ankle dorsiflexion remains <10 degrees above neutral Adequate abduction: Best sign: Ability to palpate anterior process of the calcaneus as it abducts out from beneath the talus Abduction of approximately 60 degrees Neutral or slight valgus of os calcis Technique 1….
Clinical Skills and Approaches 
Heel Pain : Mnemonic
Mnemonic: HEEL PAINS 1. Heel pad syndrome 2. Enthesopathy 3. Entrapment 4. Ligaments 5. Plantar fasciitis 6. Posterior tibial tendinopathy/tenosynovitis 7. Peroneal tendinopathy/tenosynovitis 8. Arthritis 9. Impingement 10. Neuroma 11. Spurs 12. Stress fracture 13. Sinus tarsi syndrome 14. Sever’s disease 15. S1 radiculopathy Condition Description Site of heel pain…
Surgical Skills 
Hip Spica Cast
Acceptable angulation in Femoral Shaft Fractures Age Varus/Valgus (degrees) Anterior/Posterior (degrees) Shortening (mm) <2 yr 30 30 15 2-5 yr 15 20 20 6-10 yr 10 15 15 >10 yr 5 10 10 Reference: Rockwood and Wilkin’s Fractures in Children – Leg position for Hip Spica Application in Femur Shaft…
PGMEE, MRCS, USMLE, MBBS, MD/MS
CTEV Made Easy
CAVE deformities Mnemonic Deformity Site Components C Cavus Midfoot Plantar flexed 1st metatarsal A Adductus Forefoot (Tarsometatarsal joint) Medial displacement of navicular and cuboid along with talar neck and head; Calcaneus and distal calcaneal articulating surfaces adducted along V Varus Hindfoot (Subtalar joint) Calcaneum is adducted, plantar flexed and inverted…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Compartments, Muscles and Fasciotomy of the leg
Muscle Origin Insertion Action Innervation Anterior compartment 1. Tibialis anterior (TA) Superior 2/3 lateral surface of tibia Medial cuneiform, 1st metatarsal Dorsiflexion, foot inversion Deep peroneal nerve (L5) 2. Extensor digitorum longus (EDL) Superior 2/3 of fibula and interosseous membrane Middle and distal phalanx, lateral 4 toes Dorsiflexion, toe extension…
PGMEE, MRCS, USMLE, MBBS, MD/MS 
Arthrodesis Positions
Arthrodesis is the surgical fusion of a diseased joint for the purposes of obtaining pain relief and stability. The bones are fused in a position permitting most useful function but lose their natural motion. Shoulder Flexion: 30° Abduction: 20° Internal rotation: 40° Elbow One side: 90° Both side: One in…