By C. Muntasir. Dominican University of California. 2018.

The medial collateral ligament plays an important role in In about 50% of cases purchase 200 mg prometrium mastercard, tarsal tunnel syndrome is idio- medial ankle instability purchase prometrium 100 mg without a prescription. Marked inter-individual differ- pathic cheap 100mg prometrium free shipping, whereas in the other 50% a specific cause is iden- ences are found for the main components (tibionavicular, tified, such as space occupying lesions including gan- tibiospring, tibiocalcaneal, deep posterior and anterior glion, varicosities, lipoma, accessory muscles, and nerve- tibiotalar and superficial posterior tibiotalar bands). The sheath tumors, as well as pronation or hindfoot valgus de- tibionavicular ligament is a thickened fibrous layer of the formity, and fracture of the medial malleolus and calca- ankle capsule. Patients present with a positive Tinel’s sign and ments are the longest, while the tibiocalcaneal and poste- pain, burning and numbness along the plantar surface of rior deep tibiotalar ligaments are the thickest. Spring Ligament Entrapment neuropathies of branches of the tibial nerve include entrapment of the first branch of the lateral plan- The spring ligament plays an important role in the stabi- tar nerve (Baxter’s nerve), which presents with heel pain lization of the longitudinal arch in the midfoot. Zanetti is often associated with hypertrophy of the abductor hal- decrease in diameter is most likely caused by a change in lucis muscle but is also produced by inflammation asso- the location of the neuroma, which, as it becomes dislo- ciated with plantar fasciitis and heel spur. Another cause of heel pain, often seen in joggers and long-dis- tance runners is jogger’s foot, which is produced by en- Sinus Tarsi Syndrome trapment of the medial plantar nerve secondary to valgus heel deformity. Sinus tarsi syndrome most commonly develops after an Treatment of the entrapment neuropathies is initially inversion injury (70%) and is often associated with tears conservative but may require surgical release of the of the lateral collateral ligaments. US and tients with rheumatologic disorders or abnormal biome- MR imaging are the imaging modalities of choice for di- chanics, such as pes planes deformity and posterior tibial agnosing extrinsic mechanical compression of the tibial tendon dysfunction. MR imaging has the advantage The sinus tarsi is a lateral space located between the of depicting associated denervation muscle edema and talus and the calcaneus. More medially, the sinus tarsi is continuous with the tarsal canal in which the in- Morton’s Neuroma terosseous talocalcaneal ligaments traverse. Although the latter are not truly lateral structures, they are impor- Morton’s neuroma is a benign non-neoplastic abnormali- tant in the overall function of the lateral ankle and hind- ty characterized by neural degeneration and perineural foot complex. The plantar interdigital nerves of the second and Patients with sinus tarsi syndrome present with hind- third intermetatarsal spaces are most commonly involved. Associated MR mani- neuroma and is therefore considered to be useful for nar- festations include edema, sclerosis and cystic changes in rowing the differential diagnosis of forefoot pain. US has the roof of the sinus tarsi, cystic changes at the critical demonstrated comparably good results. Morton’s neuro- angle of Gissane, lateral collateral ligament tears, and, ma is of low signal intensity on T2-weighted MR images occasionally, posterior tibial tendon tear. The use of in- the subtalar joint and subchondral cysts may be present travenous gadolinium contrast is not recommended be- in advanced cases. MR imaging Fluid in the sinus tarsi should be differentiated from permits the exact location of Morton’s neuroma, allowing the normal extension of fluid from posterior subtalar joint for precise pre-surgical planning. An MR Plantar Fasciitis effectiveness study has demonstrated that the clinical diagnosis of Morton’s neuroma is altered in more than Plantar fasciitis is one of the more common overuse in- one fourth of cases following MR imaging, and a change juries in running sports. The plantar fascia is a multilay- in location or number occurs in one-third of the remain- ered fibrous aponeurosis that extends from the postero- ing cases. These changes in diagnosis and location medial calcaneal tuberosity to the plantar plates of the prompt a change in the treatment plan in more than 50% metatarsophalangeal joints, the flexor tendon sheaths, of the feet. Large Morton’s neuromas (> 5 mm-diameter) are more When the metatarsophalangeal joints are dorsiflexed dur- commonly symptomatic than smaller ones. Post-opera- ing gait, the windlass mechanism of the plantar fascia tive outcome depends on the size as measured by MR tightens and causes repetitive traction on the calcaneal imaging. Over time, with repetitive stress, microtears ter post-surgical prognosis than a smaller one. A sim- transverse MR images is dependent on the patients body ilar process occurs at the attachment of the flexor digito- position during imaging. When the patient is in the prone rum brevis and abductor digiti minimi muscles directly position and the foot is plantar-flexed, Morton’s neuroma beneath the plantar fascia, which account, at least in part, increases in size and appears 2 mm wider than with pa- for the calcaneal spurs often seen at or close to the origin tient in the supine position with the foot dorsiflexed. Progression of the inflammatory Imaging of the Foot and Ankle 45 process leads to periostitis or even fatigue fractures of the found laterally in association with a phalangeal collateral medial calcaneal tuberosity and/or calcaneal spur. Plantar fasciitis is a clinical diagnosis that does not re- Optimal MR imaging of the plantar plate is performed quire imaging studies. However, MR imaging and US are utilizing a small field of view in the axial (long axis helpful in cases that are refractory to treatment and when views, parallel to the plantar surface of the foot), coronal fascial rupture is suspected. On sagittal and coronal MR (short axis, perpendicular to the plantar surface of the images, the normal plantar fascia is identified as a thin foot) and sagittal planes. The plantar plate is low in signal tar fasciitis include superficial or deep perifascial edema, and may be difficult to distinguish from the more super- heterogeneity and fusiform thickening of the fascia at its ficial flexor tendon.

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She also is responsible for preparing ning cheap prometrium 100mg without a prescription, he monitors the printing process for written press releases and special interest paper jams and even ink distribution prometrium 200 mg line, and stories that promote activities at the uni- he attempts to keep the printing process versity order prometrium 100mg without a prescription. There is considerable preparing reports and writing proposals pressure on the job because the presses for various projects. On evaluation increasing difficulty hearing and on eval- by an audiologist she was found to have uation is found to have mixed hearing sensorineural deafness resulting from loss, with moderate loss in both ears. He has nev- was at the 45-decibel range, and loss in the er been married and lives alone in a small right ear was at 30 decibels. She is married and lives with her husband Questions in a small city of 50,000. Bringing culture to the fore- for the elderly hard-of-hearing population: The front: Formulating diagnostic impressions of deaf deaf people we ignore. Social Work, 45(3), and hard-of-hearing people at times of medical 277–281. Disability career advancement of workers with hearing loss: and Society, 10(2), 171–189. Racial and ethnic members of under-represented groups with hearing loss and Steel, K. New interventions in hearing VR services: Explaining the disparity in closure impairment. Social work prac- New England Journal of Medicine, 342(15), tice with deaf clients: Issues in culturally compe- 1101–1109. This page intentionally left blank C HAPTER 6 Psychiatric Disabilities DEFINING PSYCHIATRIC DISABILITY dividuals’ ability to function within the environment, the degree to which their Psychiatric disabilities encompass a behavior disturbs others, and the degree broad range of conditions in which there to which the condition causes subjective are behavioral or psychological symptoms distress. The goal of psychiatric rehabili- associated with distress and/or altered tation is to help individuals develop skills function. Effective mental functioning de- and supports that will enable them to pends on a variety of social and environ- function at their highest capacity in the mental factors, as well as on the efficient residential, educational, or vocational set- functioning of structures within the brain. As with physical conditions, the degree of Psychiatric conditions are more difficult disability experienced with psychiatric to define and diagnose than are physical conditions is variable. Causes are not always identi- Symptoms of psychiatric conditions fiable, and there are no laboratory tests vary widely, consisting of both behavioral readily available to confirm the diagnosis. In many cases, the primary basis for diag- Some psychiatric conditions are charac- nosis and prediction of functional capac- terized by deficits in or loss of intellectual ity is the experienced judgment of the function, whereas others are associated professionals conducting the evaluation. Some psychiatric conditions do not status, education, and/or socioeconomic have symptoms of psychosis but rather status of both the client and the profes- changes in mood that cause distress or sional, may influence individuals’ perfor- impaired function. In still other psychiatric mance on evaluation as well as profes- conditions, intellectual function, sense of sionals’ interpretation of the evaluation reality, or mood may be unimpaired, but results. THE DIAGNOSTIC AND STATISTICAL The extent of disability experienced as MANUAL OF MENTAL DISORDERS a result of a psychiatric condition is de- pendent, to a great extent, on the degree The need for a systematic, more stan- to which the condition interferes with in- dardized approach to the diagnosis of psy- 173 174 CHAPTER 6 PSYCHIATRIC DISABILITIES chiatric conditions has been recognized conditions by defining observable symp- for well over a century. It should be emphasized that diag- ly psychiatric conditions were codified for nostic criteria should not be used to the purpose of collecting statistical infor- categorize or label people, but rather to mation, in 1952 the American Psychiatric assist in treatment planning. Association Committee on Nomenclature The DSM-IV-TR uses a multiaxial system and Statistics published the Diagnostic of diagnosis to increase specificity. Since and Statistical Manual of Mental Disorders psychiatric conditions, like physical con- (DSM-I), a book that was the first official ditions, rarely occur in a vacuum and vary manual of mental disorders that had clin- from individual to individual, the multi- ical utility. Since that time, there has been axial approach helps professionals avoid continued work to revise and refine the focusing only on specific symptoms. Rather, it enables professionals to take a As more empirical research and field comprehensive approach to identifying trials are available, reliability, descriptive other variables that could impact on treat- validity, and performance characteristics ment and help to predict outcome. Updated versions of the manual diagnosis in 1980 to clarify the complex- bear the number of the edition (DSM-II, ities and relationships of symptoms and, DSM-III, and DSM-IV). The fourth edition thus, assist professionals in more appropri- of the manual, the DSM-IV, was published ate treatment planning. The DSM-IV-TR in 1994, and in 2000 the DSM-IV-TR (4th uses five axes: edition Text-Revision) was published, rep- • Axis I describes clinical syndromes. In addition to provid- • Axis IV describes relevant psychoso- ing specific criteria by which to diagnose, cial or environmental problems that it provides consistency among profession- may have contributed to the develop- als in communicating about psychiatric ment of the condition or that may conditions. The use of the manual for affect individuals’ treatment or prog- diagnostic purposes requires specialized nosis.

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Radiation causes a type of cell trauma that is cumulative in Atrophy can occur in the cells of any organ and may be classified effect cheap prometrium 200 mg line. When X rays are administered for therapeutic purposes as disuse atrophy buy discount prometrium 100 mg on line, disease atrophy buy prometrium 100mg low cost, or aging (senile) atrophy. Immature or mi- involves the change of highly specialized cells into more general- totically active cells are highly sensitive, whereas cells that are ized, protective cells. For example, excessive exposure to inhaled no longer growing, such as neurons and muscle cells, are not as smoke causes the specialized ciliated columnar epithelial cells vulnerable to radiation injury. Viruses usually invade and destroy cells as they reproduce them- selves. Bacteria, on the other hand, do not usually invade cells Trauma to Cells but will frequently poison cells with their toxic metabolic wastes. As adaptable as cells are to environmental changes, they are sub- ject to damage from aging and disease. If a trauma causes exten- Medical Genetics sive cellular death, the condition may become life threatening. Medical genetics is a branch of medicine concerned with dis- A person dies when a vital organ can no longer perform its meta- eases that have a genetic origin. Genetic diseases are a diverse group of disorders, including mal- formed blood cells (sickle-cell anemia), defective blood clotting (hemophilia), and mental retardation (Down syndrome). Cytology © The McGraw−Hill Anatomy, Sixth Edition of the Body Companies, 2001 Chapter 3 Cytology 73 cells are called mutations (myoo-ta′shunz). Mutations either occur naturally or are environmentally induced through chemi- cals or radiation. About 12% of all congenital malformations are caused by muta- tions and probably come about through an interaction of genetic and environmental factors. Many of these problems can be pre- Normal cells dicted by knowing the genetic pedigree of prospective parents (with hairlike cilia) and prevented through genetic counseling. Teratology (ter-a˘- tol′o˘-je) is the science concerned with developmental defects and the diagnosis, treatment, and prevention of malformations. Genetic problems are occasionally caused by having too few or too many chromosomes. The absence of an entire chro- mosome is termed monosomy (mon′o-som″me). People with Turner’s syndrome have only one X chromosome and have a better chance of survival than those who are missing one of the other chromosomes. Tri- Cancer cells somy (tri′ so-me), a genetic condition in which an extra chromo- some is present, occurs more frequently than monosomy. In an attempt to better understand medical genetics, the Human Genome Project was launched by Congress in 1988 with the ambitious goal of completely mapping the human genome. Scientists are currently on the verge of determining the exact se- quences of bases with which the 3 billion base pairs are arranged to form the 50,000 to 100,000 genes in the haploid human genome of a sperm cell or ovum. The various types of cancers are classified on the basis of the Cancer tissue in which they develop. Lymphoma, for example, is a cancer of lymphoid tissue; osteogenic cancer is a type of bone cancer; Cancer refers to a complex group of diseases characterized by un- myeloma is cancer of the bone marrow; and sarcoma is a general controlled cell replication. The rapid proliferation of cells results term for any cancer arising from cells of connective tissue. How- frequently called tumors, are classified as benign or malignant ever, initiating factors, or carcinogens (kar-sin′o˘-jenz), such as based on their cytological and histological features. Benign neo- viruses, chemicals, or irradiation, may provoke cancer to de- plasms usually grow slowly and are confined to a particular area. Cigarette smoking, for example, causes various respiratory These types are usually not life threatening unless they grow to cancers to develop. The tendency to develop other types of can- large sizes in vital organs like the brain. The origi- Because the causes of cancer are not well understood, emphasis is nal malignant neoplasm is called the primary growth and the new placed on early detection with prompt treatment. Generally they do not mature before they divide and are Aging not capable of maintaining normal cell function. Cancer causes death when a vital organ regresses because of competition from Although there are obvious external indicators of aging—graying cancer cells for space and nutrients.

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Atlas of the Central Nervous System in Man generic prometrium 100mg line, 3rd Kandel ER buy 200 mg prometrium amex, Schwartz JH order 100mg prometrium mastercard, Jessell TM. Monaghan PL, Beitz AJ, Larson AA, Altschuler RA, Madl JE, Mullett Keirman JA. Immunocytochemical localization of glutamate-, glutaminase- Viewpoint, 7th Ed. Immunocytochemical identification of long ascending, pep- Adv Anat Embryol Cell Biol 1987;103:1–62. Neuroanatomy: Magnetic Resonance Imaging and Computed To- Nelson BJ, Mugnaini E. The Comparative Anatomy and Histology of the Exp Brain Res Ser 17:86–107). Cerebellum: The Human Cerebellum, Cerebellar Connections, and Newman DB, Hilleary SK, Ginsberg CY. The Central Nervous Sys- Schnitzlein HN, Hartley EW, Murtagh FR, Grundy L, Fargher JT. Computed Tomography of the Head and Spine: A Photographic Noback CR, Strominger NL, Demarest RJ. The Human Brain: An Introduction to its Functional A Photographic Color Atlas of MRI, CT, Gross, and Microscopic Anatomy, 5th ed. Inter- and intra-laminar dis- to the hippocampus mediated by stellate cells in the entorhinal cor- tribution of tectospinal neurons in 23 mammals. Baltimore: Urban & projections in primate as studied by retrograde double-labeling Schwarzenberg, 1981. Pernkopf Atlas of Topographic and Applied Human neurones of the substantia nigra receive a GABA-containing input Anatomy, 3rd ed. Atlas of Cross Section Anatomy of the Brain: Guide to anterograde tracing method. J Comp Neurol 1990;294: the Study of the Morphology and Fiber Tracts of the Human Brain. New York: Blakiston Division, McGraw-Hill Book Company, Inc, Strata P (ed). Illustrated Guide to the Central bulbospinal axons that contain serotonin and either enkephalin or Nervous System. Localization of enkephalin- Tatu L, Moulin T, Bogousslavsky J, Duvernoy H. Arterial territories ergic neurons in the dorsolateral pontine tegmentum projecting to of human brain: Brainstem and cerebellum. The posterior cranial fossa: Microsurgical anatomy and Terzian H, Ore GD. Neurosurgery 2000; 47 (Supplement); by bilateral removal of the temporal lobes. The supratentorial cranial space: Microsurgical Tieman SB, Butler K, Neale JH. Identification of cells of origin of non-pri- walk, CT: Appleton & Lange, 1995. Sylvian fissure morphology and asymmetry in munoreactive terminals synapse on primate spinothalamic tract men and women: Bilateral differences in relation to handedness in cells. Baltimore: Urban & Woolsey TA, Hanaway J, Gado MH: The Brain Atlas: A Visual Guide Schwarzenberg, 1982. The Pain System: The Neural Basis of Nociceptive Basal Cisterns and Vessels of the Brain, Diagnostic Studies, Gen- Transmission in the Mammalian Nervous System, Volume 8, Pain eral Operative Techniques and Pathological Considerations of and Headache. Bringing connection content into your WebCT courses As a first step, you will want to download from connection the files that you want to use in your courses.

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