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Do you ever experience tingling or numbness in your fingers, in hand. It could be that you’re suffering from carpal tunnel syndrome in which the median nerve is affected. Weakness in your hand is an additional symptom of carpal tunnel syndrome but there are many other similar conditions concerning the hand and the fingers. So, There are two very simple clinical tests that we can do for carpal tunnel syndrome. First of all, We have to understand the history of the patient and patients with carpal tunnel syndrome usually report that they have tingling in their hands, but, some patients also report burning sensation. It can happen that these symptoms become more pronounced with sleep. Isn’t that weird? After sleeping and taking a nap the symptoms actually get worse. So, Where is this median nerve that is affected in carpal tunnel syndrome. Well, The median nerve can be found over here and it passes underneath the transverse carpal ligament to supply the fingers with innervation. So, This is where the problems start, if the median nerve in this canal becomes compressed. The symptoms such as tingling might appear but why would it become compressed? The median nerve passes with many tendons through the carpal tunnel and some of these structures can be swollen and increase in size. So, The median nerve can become compressed because of the swelling of the tissue around the tendons. For example but also the canal itself can shrink in size. Many nerves can become irritated or damaged and therefore cause tingling sensation but carpal tunnel syndrome is a compact area that is full of all of these structures passing through it and because of that the carpal tunnel syndrome is quite common. Luckily, There are two very simple clinical tests. We can perform to check for carpal tunnel syndrome but even before we perform these clinical tests, There is one thing we can do to truly help those suffering from carpal tunnel syndrome. We can like this video And subscribe to this Channel and that will make YouTube algorithms promote this video to people suffering from these symptoms. That’s just how YouTube algorithms and algorithms of other online platforms work. If we don’t get likes of subscribers then people suffering from these symptoms will never see this video. The two clinical tests, I wanted to talk about are the Phalen maneuver and tenel sign. the phalan maneuver basically consists of fully flexing the wrist like this and then simply waiting until symptoms appear. If the patient reports tingling, that is paresthesia then the test is positive. Now to properly understand to new sign. We have to look at the transverse carpal ligament over here. The ligament we already explained underneath that ligament is the median nerve passing through and supplying innervation to the fingers by lightly tapping a little bit more proximally to the transverse carpal ligament. We might be able to affect the median nerve and if the patient suffers from carpal tunnel syndrome, He might experience paresthesia but those are just two most important tests for carpal tunnel syndrome. There are additional tests we can perform for this syndrome and there are other conditions that can cause similar symptoms a skilled and a competent doctor should be able to diagnose these conditions. 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 a video like this one then go to anatomsky.com but if you have more questions about carpal tunnel syndrome and wrist symptoms such as tingling and pain then go to this link symptomskey.com/help/wrist

Contexting too much hurt your thumb and cause pain in your wrist or your thumb. Well, There is a condition called the the quervan syndrome and I will show you one simple and easy clinical test that can help us identify this condition and possible damage of the tendons that control the thumb. Some doctors believe that the quervan syndrome is a repetitive strain injury and they claim that if you’re texting too often and too much, You could unintentionally damage your thumb and the tendons that control its movement but many doctors do not believe that the quervan syndrome is caused by texting but rather by other unknown factors. So, This scientific discussion can be very complicated and long but you know what is not complicated? Performing a simple clinical test to see if the damage to your thumb in your wrist has already been done and if the tendons are affected despite not knowing precisely what causes this condition. We have quite a few treatment options for your pain in the wrist and the thumb. So, First let’s look at the wrist, this which you can see here is the wrist and the hand from the posterior perspective. Now, if we look closely over here you’ll be able to notice the tendon of the abductor pollutus longus running underneath this ligament over here, The Dorsal Carpal Ligament. The tendon of the abductor apollosis longus is actually running this way together with the tendon of the extensor policies longus. It can be very hard to distinguish them here from one another. These two muscles perform very important functions and without these two muscles, it would be very hard or almost impossible to text using your smartphone to reach out and tap on the character A on your smartphone. You would be using the abductor apollosis longus in order to move the thumb away from the hand and other fingers. The extensor polytus brevis, however, helps us Elevate the thumb away from the display so that you’re not swiping across the screen. Now, If you do use a swipe type of keyboard, you might be using the extensor politics previous less but you still have to use it at the end of the word when you’re done with swiping because these muscles and their tendons perform specifically these texting movements. It is easy to understand why many doctors believe that the quervance syndrome is caused by excessive texting. Doctors who believe that excessive texting can cause the Quervan Syndrome claim that excessive texting causes the thickening of the appdr paulitz’s longus and the extensor policies brevis tendons. They claim that consequently, this causes pain in the wrist and the thumb. Now, if this is true we don’t really know but there is a very simple and easy test that can be performed in order to see if the patient truly suffers from the dequiring syndrome but before I explain this final step. I would like to ask you to do something in order for us to help other people learn about this possible cause of wrist pain. We need YouTube to suggest and promote our videos but that will not happen unless we get enough of likes and subscribers. So, If you can please go ahead and like this video And subscribe. Now, How can we test if the patient suffers from the so-called dequervin syndrome? The test is called the finkenstein test and it consists of placing your thumb in the center of your palm and this requires the exact opposite movement of what abductor policy slungus and the extensor politics brevis perform. The whole point here is to stress the tendons of these two muscles and this can further be achieved by grabbing your thumb with your other fingers and then flexing your wrist in the ulnar Direction like that so the Finkelstein test is basically grabbing your thumb and then flexing your wrist in the ulnar Direction and if the patient experiences pain, Well, then we consider this Finkelstein test to be positive and it indicates that the patient is suffering from the quervin syndrome but there are many other causes for pain in the wrist and a competent doctor should be able to diagnose them. 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 are a patient or you have more questions about the quervin syndrome or pain in the wrist then go to this link symptomskey.com/help/wrist

Pain in your shoulder can be a truly limiting factor in your life and while a lot of people consider the shoulder a single joint. In reality, It’s not in reality. There are two joints in the shoulder. We can see here the Acromioclavicular joint. Now, This one over here is the Clavicle but this weird looking bone is the scapula. This part of the scapula is called the Acromion and it articulates with the clavicle. So, Therefore the joint is called Acromioclavicular joint. Now, In order to see that second joint in the shoulder, We would have to look at these bones from the posterior view and this one over here is the humerus. Whereas this bone is the scapula. Now, We already saw the scapula over here. Now, We’re looking at it from the posterior view and therefore we see it like this. The joint between the scapula and the humerus is called the Clano-humeral joint. Clenohumeral joint but, why cleno? why not scapula humeral joint? Well because this fossa over here is called the clanoid fossa and that is where the head of the humerus is articulating with the scapula. So, Those are the two joints of the shoulder. The acromioclavicular joint and the clenohumeral joint but where does the pain usually happen? where does it start? Well, Besides these structures, There are many structures, nerves muscles and arteries in the shoulder and this question cannot be answered easily but there is something we can do easily that helps us identify which one of these structures causes the pain. We can perform clinical examination tests and there are two examinations I would like to highlight and explain the possible results of these examinations. The first test I want to talk about is the Empty Can Test. It is used to test the function of the supraspinatus muscle this which you can see here is the scapula and this is the humerus. They articulate here in the glenohumeral joint but that was already explained but what is this illustration up here. Well, That is basically the same region of the body with the same bones Illustrated but with the acromion removed. It was removed so that we can see the joint better and also we can see muscles over here and specifically this muscle, that is the supraspinatus muscle. The supraspinatus muscle was cut and then inverted like this but normally it originates here in the supraspinatus fossa that’s why it’s called supraspinatus. Now, Why spinatus? Well because this here is the spine of the scapula and therefore supraspinatus muscle is above that spine. So, It starts here and inserts over here. So normally, This muscle once it contracts would abduct the humerus therefore it would cause the movement like this. That’s why if we want to test this muscle, The patient is required to elevate his arms like this and point his thumbs downwards as if he’s trying to empty a can and then the examiner will apply pressure from above and try to bring his arms down. Now, The patient is required to perform an opposite movement and try to bring his arms up. If the patient experiences pain or weakness when the examiner presses from above then that might indicate an injury of supraspinatus muscle or its tendon. Now if we look closely, There is another muscle over here and that is the infraspinatus muscle. Now, infra spinatus muscle has its origin below the spine of this scapula that’s why it’s called the infraspinatus muscle. Now, The infraspinatus muscle does not attach from above over here but it attaches somewhat from the side over here. Therefore, When this muscle contracts, It actually performs a different type of movement, so, once this muscle contracts it normally performs the external rotation of the arm that is basically this movement but you know it’s really hard for someone to hold you like this and then tell you to rotate your arm externally, right? How can you oppose this rotation? Well, That’s why you should flex your arms and the elbows like this and then try to externally rotate the arm and the examiner can then oppose that movement and prevent you from doing so, a pain or weakness during this examination would indicate a possible injury of the infraspinatus muscle or its tendon. So, to test the supraspinatus muscle and its tendon, We can perform The Empty Can Test and to test the infraspinatus muscle we can perform the infraspinatus test but those are just two possible tests and they test for two possible injuries. The reason why I choose to explain these tests is because supraspinatus muscle and its tendon is most commonly injured muscle and the tendon of the rotator cuff and the infraspinatus muscle is usually injured in athletes when they’re trying to throw something strongly and far away but other structures in muscles, in the shoulder region can be injured as well. A skilled and a competent doctor should be able to find the cause of your pain. Both of you doctors and patients, You can all benefit from videos like these. If you’re a doctor you want to make a video like this one then go to anatomsky.com but if you have more questions about shoulder and shoulder pain then go to this link symptomskey.com/help/shoulder

And now, I want to talk about this organ over here. This is the pancreas. An organ most commonly known for its capabilities to produce insulin. Now, Insulin is a hormone that helps get glucose from the bloodstream into important organs such as muscles. Glucose is like fuel for the human body without it, A human body cannot function for a very long time. If for some reason, It would stop producing insulin. It helps take the glucose from the bloodstream into the cells of different organs or if these cells and the human body becomes immune to the insulin then the patient most likely suffers from diabetes mellitus type 1 or 2. This is a condition that’s very hard to deal with. In some countries, People sometimes have to calculate and ration the insulin. They have available and sadly that is sometimes truly the case, Even in the United States but even if we were talking about patients who are a while off, there are many other issues not just Financial ones. So for example, Frustration over food choices worrying about complications feeling guilty because of some underlying conditions that could have been prevented or habits and Life Choices made in the past. All of these thoughts come very often to people who suffer from diabetes and it is true successfully managing these risk factors indeed can help avoid diabetes, altogether having a healthy diet losing weight regular exercise. If you quit smoking then that’s great because smokers are 30 to 40 times more likely to develop diabetes mellitus but instead of losing sleep over these thoughts we need to focus on what’s in the future and what can be done, so that we have a better tomorrow. Now, We don’t want to wake up in a new world tomorrow that is pretty much the same like the old world from yesterday doing all these bad things and having these bad habits. Why not a healthy diet, exercise daily? Even if you’re in a wheelchair you can exercise. These risk factors are still there but there are risk factors now not for developing diabetes mellitus but for progression of diabetes mellitus or potentially also developing hypertension or kidney disease. These risk factors should be managed but that’s not what I want to talk about today because most people who suffer from diabetes mellitus, They know these risk factors and they are working to manage them in a proper way but I want to talk about one specific danger that catches many people off guard and is very lethal. But before I explain this danger and what can be done about it? There is something that you can do about it right away, right now. Many people are suffering from diabetes mellitus and we can raise awareness by sharing this video, liking it and subscribing. Primarily, Sharing the video and liking will somehow make YouTube algorithms and algorithms from other websites suggest our videos to people suffering from diabetes mellitus. Otherwise, There won’t be any audience and they will not see our videos. So, That’s something that can be done right now but now back to this dangerous condition. I want to warn specifically newly diagnosed diabetic patients about hyperglycemic crisis. That’s the condition, I want to talk about. There are two types of hyperglycemic states that I want to explain but I just can’t keep this professional posture in this video anymore. This is crazy. That new research suggests that hyper glycemic crisis cases. I’ve been more commonly in poorer areas of the country and the reason for that is, for a reason, for that might be this rationing of insulin or skipping a dose of insulin altogether, and why is that happening? A vile the finsulin costs about five, ten, twenty dollars to produce and some companies are charging as much as five hundred dollars for that, we know the prices in Canada, we know the prices in Europe, we know the prices in India and yet insulin prices in America are killing people. Both forms of hyper glycemic crisis are dangerous, Diabetic ketoacidosis is the less severe one and Hyper smaller hyperglycemic state is the more lethal one. Well, Normally our body can produce Ketone bodies and if all the glucose is in these big arteries of our body and it cannot be taken in by the muscles and other organs like biceps muscle. What can happen? is that our body can break down fat and then use that to produce Ketone bodies and Ketone bodies are then used by other organs to produce energy? They are not using glucose now but Ketone bodies and that is exactly done if there is no insulin and the glucose cannot enter organs of the human body. Our muscles can use Ketone bodies to produce energy and while that is great and that can help the work. It ultimately turns your blood acidic that results in a condition called ketoacidosis. So, Patients suffering from ketoacidosis would have glucose concentration in his blood elevated but the pH value would be reduced. This means that his blood is becoming more acidic and that is dangerous of the two percent of patients suffering an episode of ketoacidosis ultimately die from the consequences it causes. Now, Two percent is a lot however with proper treatment patients don’t die from this condition but what if you do have a little bit of insulin left and not enough to absorb all the glucose into the organs but enough to stop the production of Ketone bodies that make blood more acidic? while this means there won’t be a large excess of Ketone bodies so since Ketone bodies make your blood more acidic and if you don’t have them well that’s a good thing, right? Well, Sadly some reports suggest that people who actually experience this and who do develop this hyper or smaller hyperglycemic state have up to 20 percent chances of a lethal outcome of a deadly outcome specifically hyper smaller hyperglycemic state is one with a much higher mortality than ketoacidosis and what’s also sad about it is that it usually affects people with type 2 diabetes and there are way more people with type 2 diabetes than with type 1. But, Another trick here is that people who do suffer from type 1 diabetes usually think that they cannot have this HHS hyperglycemic crisis and they only think that ketoacidosis can affect them and that is actually not true. Yes, Mostly the HS usually affects type 2 diabetes patients but it can affect type 1 as well. This is a particularly dangerous condition and patients are basically stuck with this little bit of insulin in the bloodstream and that insulin prevents the liver from producing Ketone bodies. The Ketone bodies that normally would have been sent to peripheral organs to be used for energy production that cannot happen because the insulin is there and it prevents this process. So, Because Ketone bodies are not produced the pH value of the patient’s blood will not drop the way, It drops in ketoacidosis. In fact, Patient will not develop acidosis symptoms and therefore patient also might not notice that something is wrong and people around this patient also might be caught off guard at the same time. The glucose which is in the bloodstream and cannot be taken in by the cell of this body because the insulin is not working will Spike above 600 milligrams per deciliter and at the same time the body will try to get rid of that glucose through urine but as this glucose leaves, It will draw the water from the body along with itself. This loss of water can lead to an extreme case of dehydration. Patient’s kidneys might fail and a patient might even fall into a coma and up to 20 percent of patients admitted to ICUs with HHS eventually die from this condition. I know how hard it might be and I know it. It might even sound stupid especially if one is not in a financially good position but try to do everything you can just do not ration your insulin like everything you can. Your family loves you, ask them to help out, do not be ashamed even if you have money and you do not ration your insulin or do something like that or just survive, ask people around you to participate remind you and help you remain compliant to your therapy. I have no ways to influence the Pharma industry and I believe that I understand to a certain degree what’s going on with the prices and why. They are so high but do not ration, do not Skip and if you’re lucky and you can afford it. Do not forget your dose of insulin and this is what we can do. We can raise the awareness, we can let people know about these dangers and we can all benefit from videos like these. If you’re a doctor and you want to make videos like these then go to anatomsky.com but if you have more questions about diabetes then go to symphomsky.com/help/dm we try to help as much as we can.

Now, I want to talk about a disease that is easy to diagnose even easier to Define, But, yet the causes of that disease are complicated many and hard to find the implications are even harder to figure out the disease is anemia. Anemia is basically a disease that effects the hemoglobin concentration. In other words, the anemia is defined as a reduction in hemoglobin concentration. In our blood, If the concentration is below 11 grams per deciliter then we can diagnose a patient with anemia. So, what is hemoglobin? Hemoglobin is a protein in our red blood cells that is responsible for carrying oxygen. So, Those would be our red blood cells. This is how they look like and then inside of these red blood cells, we can find hemoglobin as a protein and it carries oxygen from our lungs. For example to our brain or our hands or other parts of our body. So, Hemoglobin is a very important protein but why would the concentration of hemoglobin be reduced. Well, not every anemia is the same. You see from kidney can failure to cancer, so kidneys in our bodies are responsible for production of red blood cells, also internal bleeding in our gastrointestinal tract. So, Here you have the esophagus and then the stomach ore here. Bleeding in these organs can cause reduction in these red blood cells. So we’re talking about the production of these red blood cells that can be decreased due to kidney failure but also losing your blood through internal bleeding. Cancers and inflammation can also inhibit the production of these erythrocytes that is the red blood cells. The cause is for anemia are many maybe you’re capable of producing these red blood cells but you don’t have the molecules which are required for production of the hemoglobin. There are two major things when it comes to anemia. One truly important thing is to determine what type of anemia it is? and then the second thing is well that can help us as well figure out what is causing that anemia? not skipping these two things is really important. It can literally save patients life. So the standard procedure once anemia has been diagnosed is to look at the so-called MCV value. The MCV value in the blood tests is basically telling us how big these erythrocytes are. These are red blood cells, the MCV valve you basically stands for mean corpuscular volume mean corpuscular volume so if the mean corpuscular volume is low. right? if the mean corpuscular volume is slow then we must check for the value called ferritin and based on that value, we can tell if the patient lacks iron. If the ferritin is low and if the MCV is low then we can assume “yes” the patient has the low iron. Iron is required to build erythrocytes of functional erythrocytes but if the patient has an increased or normal ferritin. So, we’ve first realized that the MCV value is low then we checked for ferritin and it was normal or increased. Well then the patient could have thalassemia which is a genetic disorder. So, if it’s so, if the ferritin is increased, we’re looking at a genetic disorder which the patient inherited from the parents. Well, other forms of anemia can be explained with other tests but this one is particularly important because it is very common. Low iron, low MCV value and low ferritin value. So, reduced MCV and reduced ferritin indicate low iron but is it really that simple? See low iron can be caused by bad diet but if there is a cancer in the gastrointestinal tract or in the lungs or any major inflammation. For example, covet can cause a major inflammation in the respiratory tract but also other organs such as heart. Our iron values and intake from our gastrointestinal tract can be reduced and that is very important. why? because it is often overlooked a doctor diagnoses the patient. A patient with reduced MCV and reduced ferritin and then assumes okay low iron values, it gets confirmed and then just prescribes medication and that’s it. It might increase the symptoms temporarily what if there is this underlying condition that has caused something like that one reason. Why it is so tricky with this condition? is that oh, It’s just that my iron is low and people associated quickly with the diet that they are having and they just think well you know I need to improve my diet or I’ll just take some supplements and it’s going to work out. It might work out temporarily, The major problem is if there is something catastrophic as a cancer or internal bleeding, the patient can die so it is really important to investigate this further to search for this underlying cause besides that iron deficiency anemia can actually come with normal iron levels and other lab tests can confirm it. So, besides these other lab tests, It’s important to do other investigations to search for the cause. If you’re a doctor and if you want to make videos like these then make sure you go to anatomski.com but if you’re a patient or person who’s interested in anemia you have more questions then go to symptomsky.com/help/anemia