Rheumatoid factor (RF; also mistakenly called RA factor) is an auto-antibody (commonly IgM and rarely IgG or IgA) directed against the Fc portion of IgG. Increase in both IgM and IgA RFs is almost exclusively observed in patients with RA (Rheumatoid Arthritis). Clinical Significance of Rheumatoid Factor 1. A positive…
Tag: Orthopedics
Section Editor: Dr. Sulabh Kumar Shrestha, MBBS, PGY1 Orthopedics
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Pain all over body, Sleep disturbance, Fatigue, Headaches – Fibromyalgia
What is Fibromyalgia? Fibromyalgia is a chronic illness characterized by many symptoms that occur all at once: 1. Widespread pain 2. Fatigue 3. Sleep problems 4. Cognitive disturbances (concentration, memory) 5. Altered mood (anxiety, depression) 6. Other symptoms: headache, digestive disorders, dizziness, muscle spasms, chills, low-grade fever, ringing in the…
Surgical Skills 
Bilateral V-Y (Kutler) flap for finger stump closure
Indications Classically, this flap is indicated in patients with transverse or volar oblique amputations. In actuality, the patient in whom this flap is useful generally will have an amputation where there is more tissue on the radial and ulnar margins of an amputation and exposed distal phalanx. Limitations Generally, the…
Clinical Skills and Approaches 
Subacromial Injection
Indications: Diagnostic and therapeutic purposes of – Syringe preparation: Position: Comfortably seated with the arm at the side and the hands resting on the lap. Posterior approach: Lateral approach:
Surgical Skills 
Aberdeen Knot
To end continuous suture, either a square knot, surgeon’s knot or an Aberdeen knot is required. The Aberdeen knot has been shown to be superior to a surgeon’s knot. Recommendations on number of throws: Technique/Steps:
Surgical Skills 
Running subcuticular suturing
1. Start with a buried knot at distal apex of the wound. 2. Take a bite deep to the epidermis that should curve parallel to the skin surface and exit in the same plane approximately 5-10mm along the wound, taking care to stay at the same level. 3. Continue step…
Clinical Skills and Approaches 
Injection technique for De Quervain’s Tenosynovitis
Syringe Preparation: Position: Comfortably seated with neutral forearm rotation with radial styloid facing upwards – position the wrist in slight ulnar deviation. Technique:
PGMEE, MRCS, USMLE, MBBS, MD/MS 
SCFE : Mnemonic Approach
Approach to a limping child General points Classification Management depends on 4 factors which can be remembered using the mnemonic SCFE. Stability and Severity a. Loder classification: b. Severity: Severity Southwick angle on frog-leg lateral view (Difference of head-shaft angle from normal side) Wilson slip % on AP or frog-leg…