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The hand. This anatomically complicated part of the human body has an amazing number of bones.

There are eight bones in the wrist and they all create joints. Furthermore, metacarpal bones create a set of joints with proximal phalanges and proximal phalanges create a set of joints with metal phalanges and metal phalanges create a set of joints with distal phalanges. We have so many joints in our hands because we perform so many functions with our hands. It is extremely important to keep our hands at our fingers healthy, but dangerous conditions such as rheumatoid arthritis can affect one of those joints or more of those joints, without producing significant symptoms.

Knee pain. Pain that everyone experiences once in a while. But where does it exactly start?

And what causes it?
Let’s learn about knee conditions and also their symptoms and how

to recognize them. And then at the end, let’s learn about the important signs

that we should never miss when it comes to knee pain. The knee is an interesting joint that is

capable of absorbing all the weight force of the human body and maneuvering it in a way that allows

us a wide range of movements from walking and running to jumping and dancing. This incredible

transfer of force during a jump or a delicate balance of force during dancing can be achieved

because the knee joint relies on a complicated set of muscles, menisci and ligaments to transfer

and balance this force. So while transferring this incredible force during a jump, the knee joint

can be flexed or extended, but also to some extent, externally rotated and internally rotated.

The upper bone of the knee joint is the femur, the largest bone of the human body. It articulates

down below with the tibia and additional support is provided by the fibula, laterally. This

incredibly small bone has an incredibly important function in the knee joint as it connects femur

and tibia with tendons. Tibia does not provide a very stable and deep cavity for the femur,

but the knee joint is a very mobile joint. It has to move. So where does it gets its stability?

Well, the ligaments you can see here are the anterior cruciate ligament and the posterior

cruciate ligament. Furthermore, two important ligaments in the knee joint are the lateral

collateral ligament and the medial collateral ligament of the knee joint. To absorb all the

shocks from above, the knee also contains the lateral meniscus and the medial meniscus.

And while the knee joint indeed is a triumph of human evolution that allows us to walk in an

upright way, because of these structures and so many other structures that are in the knee joint

or around the knee joint, it is no wonder that the human knee is often a location of inflammation,

injury, and pain. These knee conditions and diseases can cause pain and damage in many parts of the

knee. For example, underneath the patella or in the patellar tendon or in the quadriceps tendon.

Furthermore, the pain can be caused laterally on the femur or medially in the tibia.

But before we proceed to illustrate and show all of these things and diseases in the knee joint,

I have to ask you something. You see, we created this channel to help people suffering from knee

conditions and knee symptoms. But for some reason, YouTube still does not expose our videos

and suggest our videos to wider audiences. So there is one thing you can do for us and there

is another thing that we can do for you. Here’s the deal. You can like our videos and share them

on your social media accounts and then you could also subscribe to our channel. But make sure you

click that bell button and then choose all because if you don’t do that, there is a high chance that

YouTube will never suggest you our videos again, even though you subscribed. And if you can do

these three things for us, then there is one thing we can do for you. If you have questions

about knee conditions, then just ask down below in the comment section and we respond within 24 hours.

But now back to the knee joint. The most common cause of the pain in the knee joint

is the so-called runner’s knee and it starts right over here. It is also called the patellofemoral

pain syndrome. But how does it happen and what causes it? As the quadriceps femoris muscle

contracts over here, it pulls the patella upwards and along with it also the tibia.

This allows humans to jump and this little bone can transfer force strong enough that allows

humans to jump five feet above the ground. But how the heck does it do it? If we look at the knee

from the interior point of view, the patella can be found over here and it sits in the femoral

trochlea, a groove covered in smooth cartilage that allows the patella to glide in it. If there is too

much force applied here and too often, the cartilage can be damaged. But a single jump will not cause

runner’s knee or patellofemoral pain syndrome. In fact, it is the constant movement of patella

up and down and the force that is applied to the femoral trochlea during running that actually

causes this condition. So the patella in the knee joint can handle the force during jumping

rather well, but other structures in the knee joint cannot. So for example, the tibial tuberosity

over here and the patellar tendon over here can be damaged and inflamed and that can cause pain

in the knee joint. Namely, this condition over here, Osgood-Schlatter’s disease, can cause

inflammation in the tibial tuberosity and the patellar tendonitis causes inflammation in the

patellar tendon. The tendon connecting the quadriceps femoris muscle with the patella

can also become inflamed and that is referred to as quadriceps tendonitis.

However, the patella itself can be the source of the pain and problems in the knee joint.

The patella slides in this groove called the femoral trochlea and it can jump out of the curve,

tilt or move to the side and that way cause pain and discomfort for the patient.

That is called patellar tip syndrome, but if we move away from the patella, we could explain

these two conditions here, medial tibial stress syndrome and iliotibial band syndrome.

The medial tibial stress syndrome causes pain in the medial tibia and the iliotibial band syndrome

causes pain and inflammation in the lateral epicondyle of the femur bone. But what causes

pain in these locations in the knee? Well, in case of iliotibial band syndrome, the iliotibial band

is constantly rubbing against the lateral epicondyle of the femur and therefore it causes

inflammation and damage in that part of the knee. Here the medial tibial stress syndrome is a result

of high impact landing stress on the tibia after landing from a high jump. Almost all of these knee

conditions cause pain, tenderness and swelling in the knee joint. However, they do it in different

locations and that helps us identify them and differentiate them from one another. However,

there are two truly important signs we should never ignore that can come with pain in the knee

joint. The first truly important sign that should never be ignored with knee pain is the presence of

tingling and tingling might indicate that an important nerve is damaged or an important

artery. The second truly important sign that should never be ignored with knee pain is the

presence of chills and fever because that might indicate that a dangerous condition called septic

arthritis is present. Septic arthritis is a condition in which dangerous bacteria can leave

the joint and enter vital organs such as brain or the heart and that way cause the death of the

patient. Both of you doctors and patients we can all benefit from videos like these. If you have

more questions about knee pain or knee symptoms then go to this link
symptomsky.com/help/knee. But if you want to make a video like this one and you’re a doctor or medical student

then go to anatomsky.com. Well both of you can subscribe to this channel.

The hand. This anatomically complicated part of the human body has an amazing number of bones.

There are 8 bones in the wrist and they all create joints.

Furthermore, metacarpal bones create a set of joints with proximal phalanges.

Proximal phalanges create a set of joints with middle phalanges and middle phalanges

create a set of joints with distal phalanges. We have so many joints in our hands because

we perform so many functions with our hands. It is extremely important to keep our hands

and our fingers healthy, but dangerous conditions such as rheumatoid arthritis

can affect one of those joints or more of those joints without producing significant symptoms.

That is exactly what we have to explain. A clear diagnosis. How do we know whether a patient suffers

from rheumatoid arthritis or not? Furthermore, we have to explain mysterious symptoms that might

indicate that some deeper underlying issue is causing the symptoms. And of course, we have to

explain the therapy options according to the guidelines. There are different types of arthritis

and we’ll get to that in a minute. But first, let’s focus on rheumatoid arthritis. Where does

it all go wrong? This which you can see here are the B and T immune cells of the human body.

The B cells can produce the so-called rheumatoid factor. Rheumatoid factor is an antibody

that can create complexes with other antibodies and then deposit in the joints and contribute

to the chronic inflammation of the joints. The T cells of the immune system will not produce

antibodies and rheumatoid factor, but they can produce cytokines. Cytokines are pro-inflammatory

molecules that cause inflammation and destruction of the tissue and the joints. Now, if we would

open my chest like this, we could see a small organ here called the thymus. It is responsible

for teaching these cells not to attack our own body, but clearly in rheumatoid arthritis,

something is wrong here. So what exactly goes wrong is not known yet, but sadly, we do know

that additional immune cells called macrophages come to this region and they release enzymes

into the joints and ultimately cause damage. They can also activate fibroblasts and fibroblasts

are supposed to repair the damage, but they cannot do it in the right way or in the right spot.

And so, the permanent damage to the joint is done and this can have serious consequences

for the life quality and health of the patient in the future. These dangerous developments

not always cause symptoms and therefore they can be hard to recognize. A lot of people suffer

from rheumatoid arthritis, but they are not yet aware of it. So what can be done about it

and how can we easily diagnose it before serious damage has been caused? But before I explain this,

I have to ask you something. You see, we have a problem here. We created this channel to help

people suffering from rheumatoid arthritis and other conditions and then we get hundreds and

hundreds of comments posted by someone called Dr. Osaiye. Honestly, I doubt that this person

is even a doctor. He claims that he has some magical treatment that can cure all diseases

and they spam our channel. We get hundreds of comments just, you know, flat out lying

to the people that they can cure the diseases. I find their channel and they have more views

than we do. They have more subscribers than we do. I don’t know what YouTube and other

social platforms are doing with their algorithms, but we need to find a way to tell YouTube

and other platforms that we’re legit and these guys are a scam. Think about how immoral that is

to find people suffering in pain and to scam them out of their money. You know they’re suffering

and you know that what you’re offering them does not work. So there are three things you can do

and we can also do one thing for you. Three things are you can share this video. Just grab the link

and share it on your platform, on your accounts or social media with your friends and then you

can come back here to this video and just like it and subscribe. And then when you subscribe you

have to click that bell button because YouTube will still not offer you our videos unless

you click that bell button. It’s not going to suggest you our videos and then you can like the

video so that’s what you can do for us. What we can do for you is we can you have a question

about this condition. You have a question. You have a question about rheumatoid arthritis.

Ask the question in the comment section. We reply within 24 hours, but now back to our joints.

How to treat it? Well the treatment of rheumatoid arthritis depends a lot on the underlying activity

of these cells and the molecules they produce. There are three specific things I’d like to

highlight when it comes to treatment of rheumatoid arthritis. First and foremost, we know that exercise

and physical therapy help but the first line treatment for rheumatoid arthritis is typically

non-steroidal anti-inflammatory drugs. These wildly used non-steroidal anti-inflammatory drugs such as

ibuprofen are not the only drugs we use for rheumatoid arthritis. There are biologicals.

Those are given by injection. Jack inhibitors are the newest drugs for rheumatoid arthritis

and DMARTS stand for disease modifying anti-rheumatic drugs. Steroids cannot only get

rid of the pain, they can also reduce stiffness and inflammation in the joint. The mechanisms

through which these cells cause damage to the joints are diverse, but so are the mechanisms

through which these drugs try to stop that. So one size fits all definitely does not work here.

The exact combination of medications will depend on other medical conditions but also on the

activity of rheumatoid arthritis. One combination of medications can do wonders for one patient

and cause nothing but side effects for the other. If it’s not enough to treat rheumatoid arthritis

with medication we can look at surgical options that are available but we have to go all the way

to the beginning where the inflammation starts. Now what is this over here? This is a bone which

with its head is articulating with another bone and this constitutes a joint. Now this part over

here is the joint capsule with the synovial membrane and that is exactly where the inflammation

and rheumatoid arthritis starts. But rheumatoid arthritis does not only cause inflammation of

the synovial membrane around the joints. If I were to open my hand like this you would be able to see

the synovial membrane over here as well wrapping around the tendons of the muscles of the hand. If

the rheumatoid arthritis causes an inflammation of the synovial membrane around the tendons it can

ultimately cause the tendon to rupture and this has to be quickly repaired. Furthermore, if it

causes the inflammation of the synovial membrane around the joint it can destroy the joint surfaces

and this too can be repaired by simply removing the synovial membrane and it can be done

arthroscopically or through an open surgical approach. Surgery basically means that we have to

go through the skin of the patient and that is invasive. So let’s first look at the diagnosis

and how can we make sure that the patient indeed suffers from rheumatoid arthritis. There is no

single clinical or lab test that can confirm the presence of this condition. So therefore we have

to look at these seven criteria over here in order to diagnose rheumatoid arthritis. If the

joint is severely damaged, it can be completely replaced but before we get to any surgeries

because they’re invasive, let’s make sure that the patient indeed suffers from rheumatoid arthritis.

In order to diagnose someone with rheumatoid arthritis we have to look at these seven criteria

and four out of these seven have to be positive. The first criteria here to diagnose someone with

rheumatoid arthritis is morning stiffness that lasts longer than one hour. Furthermore soft

tissue swelling of three or more joints and the third criteria in this list is basically swelling

of the proximal interphalangeal joints. Furthermore swelling of the metacarpophalangeal joints and

swelling of the wrist joints. The fourth criteria is symmetric swelling of the joints bilaterally

and these four first criteria have to be present longer than six weeks. The last three criteria for

the diagnosis of rheumatoid arthritis are the presence of rheumatoid nodules. For example here

subcutaneously, that means under the skin. Furthermore rheumatoid factor in blood tests

can be positive and radiological confirmation of the changes that are indicated in rheumatoid

arthritis can be helpful. In radiological imaging for patients who suffer from rheumatoid arthritis

sometimes it is possible to see mysterious signs such as Heberden’s nodes and Bouchard’s nodes.

These findings can indicate that the patient not only suffers from rheumatoid arthritis but

also from osteoarthritis and this is really hard to deal with and that might be an explanation

why an appropriate therapy that is in accordance with the guidelines still does not help. But both

of you doctors and patients we can all benefit from videos like these. If you’re a doctor and

you want to make video like this one then go to anatomski.com but if you have more questions

about osteoarthritis, rheumatoid arthritis just go to symptomsky.com/help/arthritis

and both doctors and patients can subscribe.

So, If you fractured your radius that is this bone over here. You’ll probably have questions such as was the treatment appropriate. You know could this cause pain and arthritis or stiffness in the future. What kind of treatment is necessary and can radius be treated without a surgery? I want to explain three things, When it comes to answering these questions, Three important things as already mentioned this over here is the radius bone. It articulates with the bones of the wrist and with the ulna distally but it also articulates with the ulna more approximally at the elbow joint. It also articulates with the humerus of the elbow joint and it facilitates the insertion of the biceps muscle and therefore it helps perform the flexion at the elbow joint and why are we talking about this bone? Well, Normally when people lose balance and fault in our ground they tend to fall on their wrists in order to preserve some stability during the accident and also to avoid hitting a hard floor or on the ground with their head because of this radius can fracture easily. Almost 25 percent of all the fractures are the distal radius fractures. Now, If we look at this region from the Palmer View and remove the skin and the underlying tissue you might notice that there are many structures here, this, which you can see here is the transverse carpal ligament underneath that ligament. There is the median nerve and many tendons around it coming from important muscles of the forearm a little bit more medially, We can see here the ulnar artery providing the important blood supply for the wrist and the hand right next to it is the ulnar nerve and so because of all of these structures so densely packed in this region. It is quite understandable unless this bone fracture is treated appropriately. The patient might experience pain arthritis as a consequence of a badly planned treatment of the distal radius fracture. These densely packed tendons in this region are important for mobility of fingers hand and the wrist and therefore if they are affected the patient might lose mobility and experience stiffness in the joint as if that wasn’t enough this region has many bones and barely 30 to 40 percent of distal radius fractures treated in a non-surgical way results in acceptable alignment of the bones. This is the distal part of the radius, here you can see the distal part of the ulna here. The scaphoid bone, The lunate bone, The triquetral bone trapezium and the trapezoid bone capitate and the hemate bone. Furthermore, There are additional five bones over here. The metacarpal bones, one for each finger because of so many little bones involved over here. It can be sometimes hard to achieve a satisfactory level of alignment of these bones. A badly planned therapy of a distal radius fracture can have permanent and serious consequences for the patient. Before I explain these three factors that indicate a necessity for a surgical treatment of the distal radius fracture, I would like to ask you to like this video And subscribe to our Channel. As already explained, This is a common fracture and a lot of people who experience symptoms such as pain and stiffness will not see our video unless you like it and subscribe to our Channel, That’s simply how the algorithms of YouTube and other online platforms work. Furthermore, They will not even show you our videos unless you really go ahead and click that bell button which is quite annoying. So, if you’re already subscribed and like this video, let’s continue one truly important factor that indicates the necessity for a surgery is the age of the patient and the way the radius has healed. We can see that on an example of radial inclination this angle over here is radial inclination and normally it is 23 degrees but a redistal radius fracture can reduce that furthermore, there is a term called Volar Tilt. Now if we were to create a sagittal section through the distal radius. You would notice that the articulating surface of the distal radius is not flat like this instead it is tilted in the volar direction. This way a distal radius fracture can reverse that and cause the so-called dorsal tilt of the articulating surface of the distal radius as you might have noticed joint surfaces and their alignment are really important but it’s not just their alignment that matters it’s also their quality and smoothness that is really important a lot of distal radius fractures actually happens right through the joint surfaces. It means that the surface itself fractured and there was an opening a gap now after the distal radius is repositioned. It could happen that on that joint surface, A step off is present along the lines of the fracture. If the step off is higher than two millimeters then a surgery might be required to fix that and last but not least. The third thing, I wanted to highlight about distal radius fractures a special form of distal radius fractures, The Smith’s fracture as it was already explained most of the distal radius fractures happen as the patients land on their wrists dorsiflexed. Now, This is dorsiflexion of the wrist now that dorsiflexion can be minimally performed or the patients might also land on their wrists completely flexed and that is when Smith’s fractures happen so the first reason I wanted to highlight for a surgical treatment of the distal radius fracture is basically a misalignment of the bones that might appear and we can see that on an example of radial inclination and that is this angle over here which is normally around 23 degrees but it can be reduced if a distal radius fracture has occurred furthermore the second reason I wanted to highlight was a possible step-off that appears as a possible consequence of an intra-articular distal radius fracture where the fracture happened inside of the joint on the joint surfaces as well and if the patient lands on his wrists flexed then he might experience the so-called Smith’s fracture and that is the third reason for a surgical treatment of the distal radius fractures that I wanted to explain. Both of you doctors and patients, We can all benefit from videos like these. If you’re a doctor and you want to make a video like this one then go to anatomsky.com but if you have more questions about bone fractures or distal radius fracture then go to this link symtomsky.com/help/fracture

Did you ever ride your bike really fast with a lot of vibrations? Well, I know, I did and while many cyclists already know that. That way they can damage the pudendal nerve that innervates important organs such as the penis and vagina. Not many cyclists know that they could also injure nerves in their hands as they experience constant vibrations and stress from the handlebars. The condition I’m referring to is called ulnar nerve syndrome. It can be dangerous and slowly leave the fingers of our hands paralyzed. There are two simple tests that assess the nerve that can be damaged here but where does this all take place? Well, This which you can see here is the hand from the Palmer View and this over here is the ulnar nerve from this site. We can also see the median nerve over here a little bit more laterally but it is specifically this ulter nerve that we’re interested in. This nerve innervates the medial side of the hand and the little finger. It also innervates the medial side of the ring finger but there’s also the deep branch of the ulnar nerve and it goes underneath. All of these structures over here, This ligament is the transverse carpal ligament and underneath, It is the median nerve with many tendons. Now, Let’s remove all of these structures, so we can see the deep branch of the ulnar nerve and here we can see the deep branch of the ulnar nerve. It innervates this muscle over here, the Adductor Policies and because of that muscle, the thumb can be adducted the ulnar nerve, the nerve that innervates the hand fingers but also muscles can be injured in cyclists because of the way we hold the handlebars but before I explain two simple tests for ulnar tunnel syndrome, There is one thing we can do to prevent this condition. We can subscribe to this channel and like this video. YouTube and other online platforms will not show this video to other cyclists around the world unless we get enough of likes and subscribers, that’s just how their algorithms work. The symptoms of the ulnar tunnel syndrome can be subtle and people might not notice these symptoms right away. So, A skilled clinician should be able to perform this tenels sign provocative test and basically it consists of finding where the nerve is and then tapping the nerve and if the patient experiences tingling that is paresthesia. Well then, The test is positive. This second simple test that can be performed is the from and sign provocative test and it consists of trying to take away a piece of paper from the patient and patient is asked to hold the paper tightly with his thumb. So, Basically this way now the clinician would be trying to take the paper away from the patient and if the patient cannot hold the pain paper and then compensate by flexing the thumb. This way well then the test is positive. Now ,if you remember at the beginning of this video. I explained that the ulnar nerve innervates of the adductor policies that is the adductor of the thumb and that muscle performs the adduction of the thumb. Now, If the patient suffers from ulnar tunnel syndrome in which the adductor policies innervation is severely affected then he might not be able to perform this adduction strongly enough to hold that sheet of paper. So, What the patient ends up doing is flexing his flexor policy slungus and that way flexes the thumb in order to provide more strength to hold that sheet of paper which eventually might even slip if the patient has severely affected iteration of the at doctor pollicis. This is a dangerous condition and it can leave our fingers paralyzed. Other conditions such as compression of the ulnar nerve at the elbow can cause similar symptoms. A skilled and a competent doctor should be able to diagnose these conditions. Both of you doctors and patients, We can all benefit from videos like these if you’re a doctor and you want to make a video like this one then go to anatomsky.com but if you have more questions about pain tingling or weakness in your wrist and your hand then go to this link symptomskey.com/help/wrist